Problem Solvers

Staying Safe While Sleeping

Providers need a checklist or process to help them ensure a patient’s bed safety.

The bed is often thought of as a place of refuge. A place where one can settle in after a long day and enjoy a peaceful night of rest while throwing all theircares to the wind.

However, for the disabled or elderly, a bed can pose a number of safety risks. Between Jan. 1, 1985 and Jan. 1, 2010, the U.S. Food and Drug Administration received 828 incidents of patients caught, trapped, entangled or strangled in hospital beds. The reports included 493 deaths, 141 nonfatal injuries and 194 cases where staff needed to intervene to prevent injuries. Most of the affected patients were frail, elderly or confused.

There are literally hundreds of bed safety risks, ranging from pressure ulcers to smoking a cigarette in bed, and using candles near a bed, according to Phil Cunningham, business manager for home care and long term care beds for DME manufacturer Invacare Corp.

“Those are more of the issues where it’s not so much about the product that you’re picking,” Cunningham says.

Three Big Risks

But there are three big categories of risks that providers need to take into consideration when it comes to the bed itself: falls, entrapment and electrical shock. These are the risks that can lead to catastrophe.

When patients fall out of the bed, they can potentially hit their head or break a hip or arm. Falls can occur by rolling or transferring out of the bed.

The second risk, entrapment, occurs when a bodily part or extremity gets caught in between the rail and mattress or the rail and headboard. This can cause a patient to fall out of bed and damage something or get entrapped or entangled, and it can result in death.

Electrical shock can occur when the bed is not grounded properly and wires get frayed over time. “There is a risk of the wire coming in contact with the metal frame that can result in electrical shock,” Cunningham notes.

Reducing Risks

So, the overriding question becomes how can providers help ensure patients stay safe in their beds? It starts with leadership.

“The provider should be the one that’s driving the patient safety with the bed,” Cunningham explains. “They should work with healthcare provider, whether it’s the doctor, referral source or caregiver, to identify if the patient at risk for falling.”

This means considering if the patient is ambulatory and able to move around or if the patient has balance issues or bouts dementia.

“It’s not the (HME) provider’s job to prescribe rails or to assess the patient to decide if they needs rails or not,” Cunningham explains. “It’s really the caregiver’s job.”

Providers do need to make sure the caregiver, referral source or doctor is educated on what the risks and benefits of bed rails are to the patient. Patients not at risk for falling may not need bed rails, according to Cunningham.

“Maybe a low bed is a better option. It minimizes the distance they would fall out of bed and land on the ground and reduces risk of injuries,” he says.

Maybe someone is at risk for falling, so rails are the best option, but it’s important to keep in mind the risk of entrapment.

“Rails will help with assists and transfers and making sure the patient doesn’t roll out of bed,” Cunningham says.

Another way providers can reduce risks is to educate the end user and the caregiver about bed safety and things to watch out for. If there are no rails, patients need to know they shouldn’t transfer on their own. If there are rails, caregivers need to make sure to check on the patient on a regular basis, watch the entrapment areas and watch for bedding to get wadded up around the rail.

Cord Care

Providers should make sure the cords are all tucked and out of the way, that caregivers know the cords are not protected and can be frayed by sweeping the fl oor or if a cord is in the middle of the floor, there is a risk that the patient could trip over it. All of the cords should also be inspected for frays or damage before the technician leaves.

“They should also make sure any bedside furniture is not in the way to make it awkward to get out of the bed…so there are no obstructions around the bed that would hinder the transfer process,” Cunningham says.

Eliminating Risks through Setup and Maintenance

Once the equipment is set up, providers should check that everything is set up properly, especially if the product is a rental.

“They should really look to make sure that the rails are not bent outward, that there are no loose bolts on the hardware, just go through and tighten everything up and do a quick inspection,” Cunningham says.

If the patient is using a therapeutic support surface, such as an air mattress, it needs to be strapped to the bed, but not to the subframe so the head and foot section can still move. Providers should also make sure all the mattress keepers are in place and are properly engaged and that there are no chair rails or something up against the wall that the bed may be pushed against.

Beds should be checked at least annually to make sure the patient still needs rails, the rails are tight and that the frame is still solid and intact. Cords that are frayed or damaged should be replaced. Also, mattresses also need care.

“As mattresses get older and either the foam or the springs break down, you do have to worry about entrapment,” Cunningham explains.

So, the mattress should be secure with the mattress keeper. If not using rails, there should be another way to secure the mattress to keep it from sliding around and creating potential hazards.

While beds help people recuperate or live with long-term conditions, they can injure or kill them if not properly set up. Proper education of the end user, caregiver and referral source by providers can help ensure patients experience safe, peaceful slumber.

This article originally appeared in the May 2012 issue of HME Business.

About the Author

Cindy Horbrook is the associate editor for HME Business, Mobility Management, and Respiratory & Sleep Management magazines.


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