Understanding the key factors required for hybrid mattresses: analysis of a focus group (the Somlent Serene Hybrid Mattress)

Background: This paper presents the results of one area of a tripartite study; laboratory testing; focus group and clinical case series investigating the use and effectiveness of the Somlent Serene Hybrid Mattress. The prevention and management of pressure ulcers (PUs) has long been a key indicator of quality of care and a major focus for health care providers, as the ageing population continues to grow there is an increased risk of skin damage to this vulnerable patient group (Fletcher et al, 2015). Similarly, the quality of care delivered by health care professionals and the National Health Service Trust (NHS) is being monitored through the incidence of PUs e.g data collected via the NHS Safety Thermometer (Cooper et al, 2015). Adequate reduction of excessive pressure and/or shearing forces is essential to enable sufficient tissue perfusion for the successful prevention or healing of PUs. The use of support surfaces, including high quality foams, hybrids and alternating pressure air mattresses (APAMs), are an effective strategy for relieving/redistributing pressure (Moore et al, 2014). Hybrid support surfaces are a more recent technology in comparison to foams and APAMs which are becoming increasingly accepted as an alternative treatment option. Innova Care Concepts have launched their new ‘active’ Hybrid mattress, the Somlent Serene. The aim of this study was to explore and investigate perceptions of the mattress and its application in the clinical setting.

Method: A qualitative approach was implemented using a focus group design. Key opinion leaders were invited to participate (n=5); an academic, infection control specialist and tissue viability specialists. Ethical approval to undertake and publish results was successfully received prior to the focus group. To stimulate discussion participants were asked “what their initial thoughts of the mattress were?” Subsequent questions followed to promote discussion. All information was recorded, transcribed verbatim and data was analysed thematically. All participants were assured of confidentiality and anonymity.

Results and discussion: All participants admired its simplicity, ease of use, quietness and design. The fact the foam does not lie on top of the air cells was highlighted as good practice as it potentially reduced pressure and/or shearing forces. Four key themes were identified; patient suitability, unit cost per system, importance of inter-professional working and promotion of cost effectiveness. Patient suitability for hybrids was highlighted as participants discussed potential confusion of clinicians who often found it difficult to decide when a hybrid should be the mattress of choice. The development of an evidence based flow chart that would assist clinicians to make an informed choice was recommended to allow for the matching of clinical need with the appropriate mattress available to prevent avoidable pressure damage.

The second major theme emanating was that of unit cost per system. In an economic climate that demands cost effectiveness and saving of money, costs of hybrids can be more expensive than other systems. It was suggested that research and evidence supporting each system should comprise of clear patient outcomes including the effect of hybrids on skin (prevention and management of skin damage); cost effectiveness; ease of use for the clinician; comfort for the patient and infection prevention qualities of the system.
The importance of inter-professional working with mattress development emerged as another key theme. This multi-disciplinary group of participants was intentionally selected as infection control and tissue viability specialists do not always work collaboratively. Significant aspects of the hybrid mattress were identified, for instance strategies for preventing infection control risk.

An additional theme was promoting cost effectiveness of the hybrid mattress. Ensuring appropriate equipment use whilst providing high quality care was identified. Participants suggested inclusion of a unique bar code on the mattress, cover and pump emphasising this could potentially prevent mattresses being misplaced, inappropriate use and act as a tool for audits.

Conclusion: The consensus was that there is a place for hybrid mattresses in preventing and managing pressure damage effectively. The importance of TV and infection prevention working collaboratively with industry to develop an effective product was identified. The development of a flowchart guideline, supported by high quality evidence, was recommended for all heath care areas to access and refer to thus ensuring correct choice of appropriate equipment. Mattress choices for use in clinical practice should be based on research evidence assessing benefit, harm and cost effectiveness. Further research, in a clinical and laboratory setting, investigating the use of this Somlent Serene Hybrid mattress is currently being conducted, and will be reported at a later date.