Breaking News: National Pressure Ulcer Advisory Panel (NPUAP):New “Hand Check” White Paper Hot off t

As seen in the Consultant Connection December 2014 Issue
Erin McClure, BSN, RN, WCC, Nurse Consultant, ICP, Inc.,
On November 21, 2014, the NPUAP sent out in email introducing the newest addition to their white paper library which is titled, “Hand checks: Are They an Effective Method to Monitor Support Surfaces for Bottoming Out?”   To view this white paper, along with other publications, please visit the NPUAP website at:
The overall objective of this article and published white paper is to determine whether the long practiced “hand check”, which determines adequate pressure redistribution, is a valid bedside testing tool.  Below are reasons listed why hand checks should not be performed, as stated by the NPUAP consensus panel:
  • Hand checks create the potential for infection risks for both the patient and the caregiver.
  • Hand checks could create shearing injury of fragile or moisture compromised skin.
  • Safe hand checks for bariatric individuals require multiple staff members, and the resultant repositioning alters the immersion making the hand check invalid.
  • Hand check characteristics vary with the elevation of the head of the bed and patient positioning.
  • Hand checks are subjective and not reliable.
  • Certain therapeutic support surfaces are designed so that hand checks for bottoming out cannot be properly performed
  • Visual observation combined with surface compression may be useful to provide indicators of surface immersion failure.
The conclusion in the NPUAP White paper states:
“Hand checks” have been historically used to assess bottoming out of mattress overlays at the bedside. No evidenced-based research exists to support the practice of using hand checks. With advances in therapeutic support surfaces and mattress replacement systems, hand checks are not an effective or safe assessment technique to monitor these newer technologies. The use of hand checks was removed from the International Pressure Ulcers Guidelines in 2014. Additional research is needed to provide a bedside method to determine when a support surface has bottomed out. “ 
In conclusion, please be aware of this new practice information.   Sign up for updates from the NPUAP, and other reliable resources which set forth the standards of practice for pressure ulcer management.  Be vigilant and use strong observation skills to determine if a support surface is adequately redistributing pressure with prevention being the key to success.
Works Cited
Hand checks: Are They an Effective Method to Monitor Support Surfaces for Bottoming Out? A White Paper from the National Pressure Ulcer Advisory Panel. (October , 2014). Retrieved from The National Pressure Advisory Panel:

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