Problem Solvers

Sleeping Safe and Sound

Why providers need to emphasize bed safety, and how they can do it.

Every one of the beds you have deployed to your patients’ homes could harm those patients. That’s a jarring, terrible thought, but it’s true, and it’s something all providers of beds need to constantly be mindful of,and take steps to prevent.

Not all providers realize the risks involved with beds, because the threats are so non-tangential — someone getting trapped and tangled in a bed rail to the point where they suffocate and die is almost completely unexpected. Sure, there’s documentation out there, but what provider expects it to happen to its patients — on its bed? It’s so statistically unlikely that is seems far-fetched.

But it happens. According to the U.S. Food and Drug Administration’s “Practice Hospital Bed Safety” pamphlet, between 1985 and 2009 the administration received reports of 803 incidents of patients caught, trapped, entangled, or strangled in hospital beds. The incidents amounted to 480 deaths, 138 nonfatal injuries, and 185 cases where someone could intervene to prevent an injury. Most of the affected patients were frail, elderly, or confused.

With 1.5 million beds out in the marketplace, even 22 deaths on average a year is a risk that providers should prepare for, says Phil Cunningham, business manager of Homecare Beds for Invacare Corp. The risks are immense. The provider could face lawsuits from the patient, and the patient’s family and other dependents. The Department of Justice maintains a substantial budget for healthcare litigation (approximately $749,000 per case). And the provider faces a multiplicity of other market-based threats, as well.

“Any time you have something that happens under your watch as a provider, you will have to fight all the all of the public relations nightmares; all of your referral sources are going to be concerned; your competitors in your local market are going to jump all over you,” he catalogs. “It can decimate a business.”

So while the risks are minimal the penalties for that risk will kill an average business. But there’s another more horrible reality than just the financial threats, Cunningham notes.

“The part that I think everyone kind of forgets when they talk about this is, a person died, or got hurt, and from the equipment that was supposed to make them better,” he says. “It’s a scary proposition.”

Protecting Patients and Your Business

So what can providers do to protect their patients from entrapment and other bed safety risks, and mitigate the risks to their businesses (and their peace of mind) in the process?

Sure, when a bed is new out of the box from the manufacturer, it has ostensibly been tested by that manufacturer to meet all safety guidelines (assuming the bed came from a quality manufacturer), but that provider is still on the hook the moment it takes possession of the bed and puts it under a patient. Variables such as patient diagnosis, physical condition, mobility issues, age of mattress, and how caregivers perform transfers all add up to an equation for which the provider is still responsible. It’s a sobering thought, and one providers should take to heart throughout their bed business.

The provider should firstly work with referral sources to assess whether the patient needs rails. Patients that are mobile and can do everything they need to do, and are not a flight risk, and are not at risk of falling out of the bed are not only not in need of rails, but could actually be at risk for entrapment if they had rails, Cunningham notes.

“A bed without rails, almost eliminates all entrapment zones,” he says. When the provider delivers and sets up a bed at the patient location, it should educate the end user, caregivers, family and other possible attendants to show all the areas of a bed where the patient could get trapped, and how. Show them the places between the mattress and the rail, the inside of the rail, the space between the rail and the headboard, and all the common areas of entrapment.

They provider should also address possible concerns such as holding onto the rails during transfers and accidentally bending them inward or outward; the fact that spring mattresses can wear down and create entrapment points; bedding that can get bunched up around the rails; and the importance of maintaining overall bed frame integrity.

Providers should engage in regular, periodic “bed checks” of beds to ensure that they are in good shape and that the structure is intact. All bolts should be tight. All parts should be in good condition. Any and all rails should be in their proper shape and not deformed due to poorly handled transfers. In fact, any time a technician delivers something to the patient (perhaps oxygen equipment or some other supply) it would be a good idea for that tech to quickly inspect the bed.

Also, providers can purchase a B4000 Bed System Measurement Device from National Safety Technologies, which is an instrument for measuring the gaps in various entrapment zones, and deploy them to staff as part of their set-up and periodic bed inspections.

Having the Right Beds

In addition to process, another thing to consider is the overall quality of the beds the provider is using. Providers should inspect their “fleet” after use and determine if it is standing up to five years’ use from patients. If not, then the provider might want to start transitioning to other gear. Even if the front-end costs is slightly more, the back-end protection from possible legal liability is inestimable.

There are a couple marks of durability for beds that a provider can look for. The first is Underwriter’s Laboratory code 962, which is for household furnishings, and then there is a more detailed 60601-2-38 (which is in the process of being upgraded to 60601-2-52), and that is more specific to hospital beds. It addresses lateral stability for tipping prevention, safe electronics, and bed longevity.

In the case of the 60601-2-38, there’s an added benefit: UL monitors the production process to ensure the bed lives up to manufacturer claims. This delivers some peace of mind for the providers because it means that the manufacturer can’t change the bed without updating UL.

No one wants to consider the thought of a trapped, panicking patient desperately seeking help, but it’s a concern providers need to address. Fortunately, these are steps a provider can put into place to ensure anypossible nightmares are eclipsed by a safe, sound, peaceful sleep.

This article originally appeared in the November 2011 issue of HME Business.

About the Author

David Kopf is the Editor of HME Business.

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