Table 1.

Inclusion and exclusion criteria

Inclusion criteria

1. Evidence of acute illness through:

a. acute admission to secondary care hospital, community hospital or NHS-funded intermediate care/rehabilitation facility

b. secondary care, community hospital or NHS-funded intermediate care/rehabilitation facility in-patient with onset of acute illness secondary to elective admission

c. recent secondary care hospital discharge to community hospital or NHS-funded intermediate care/rehabilitation facility

2. Aged ≥ 18 years

3. Have an expected total length of stay of 5 or more days

4. At high risk of PU development due to one or more of the following:

a. bedfast/chairfast AND completely immobile/very limited mobility (Braden activity score 1 or 2 and Mobility score 1 or 2) [20]

b. Category 1 PU on any pressure area skin site

c. localised skin pain on a healthy, altered or Category 1 pressure area skin site

5. Consent to participate (written informed consent, witnessed verbal consent, consultee agreement (England) or nearest relative/guardian/welfare attorney (Scotland))

6. Expected to comply with the follow-up schedule

7. The patient is on an electric profiling bed frame

Exclusion criteria

1. Have previously participated in the PRESSURE 2 trial

2. Have a current or previous Category ≥3 PU

3. Have planned admission to ICU where standard care is alternating-pressure mattress provision

4. Unable to receive the intervention (for example, sleep at night in a chair or unable to be transferred to randomised mattress)

5. Patient weight is lower or higher than weight limits for HSF and alternating-pressure mattresses (<45 kg/>180 kg)

6. It is ethically inappropriate to approach the patient

HSF high-specification foam, ICU intensive care unit, NHS National Health Service, PU pressure ulcer