This section is concerned with hospital beds, also known as care beds or nursing beds, designed for individuals with special needs.
A proper assessment by a suitably qualified professional is important, in order to make sure that the correct piece of equipment is chosen. The current safety standard for hospital beds is BS EN 60601-2-52, which came into force on 1st April 2013.
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Profiling hospital beds which are electrically adjusted enable the user’s position to be changed without strain for anyone involved. The most common profiling beds are three and four part. Either of these will allow the backrest / pillow area of the bed to be raised, enabling the user to be more upright, while also lifting an area under the knees, to stop the user slipping down in the bed. A four part bed can be more comfortable, as it keeps the bottom horizontal while raising the knees. Two part beds just have a rising headrest area, while five part profiling beds offer more variability in the head / back support area.
There are considerable advantages to a profiling system:
• by changing position without manual involvement, the risk of injury to the carer is eliminated, and the independence and dignity of the user are maintained.
• it may make it possible for someone to get out of bed unaided, if they can raise themselves into a sitting position first.
• respiratory and circulatory difficulties can be eased.
• it makes using a hoist easier.
• most profiling beds also have a height adjustment, so the carer can work at a safe height when giving treatments, etc.
Mattresses for use on profiling beds should have the same number of sections as the bed. There are foam and sprung versions available. For anyone who has limited mobility and spends a great deal of time in bed, a compatible pressure relief mattress should be chosen.
For patients who are liable to fall or climb out of bed and hurt themselves, an ultra-low hospital bed is ideal. Until recently, many vulnerable patients were nursed on floor mattresses, a practice that is clearly not suitable for reasons of hygiene, dignity and carer health.
The options now available include straightforward low level beds, designed to accommodate a mobile hoist (an important consideration in the selection of any care bed), as well as ultra-low electrically powered profiling beds, which offer all the advantages described above, including the ability for the carer to work at a height which is safe and convenient for them, before returning their patient to a much lower level.
For extra security, safety rails may be used (see below) and / or a thick supportive mat be placed next to the bed, to cushion any fall. Care must be taken in this case, to ensure that the patient cannot become entrapped between the bed and the mat.
King’s Fund Beds
Designed by a team led by Bruce Archer from the Royal College of Art in the 1960s, The King’s Fund Bed set the standard for hospital beds, with its tilting and height adjustment mechanisms. It is still apparently used in 85% of hospitals.
It is, however, rather large and difficult to manoeuvre, and crucially, the adjustments are manual, making them hard work for care staff. Increasingly, the King’s Fund Bed is being phased out in favour of more user-friendly and responsive powered adjustable beds.
For anyone who cannot alter their position independently, a postural management programme can help to counteract the tendency to develop an asymmetric posture. At night, positioning systems can carry on the work undertaken with specialist seating systems during the day.
Systems are available to support users lying on their side, or in a prone or supine position. Depending on the type chosen, the supports can be used with a profiling bed, and laid flat when required, to make transferring in and out of the bed easier.
Beds to help you Sit or Stand
Rotating chair beds are designed to help people who are weight-bearing, but unable to get into and out of bed unassisted. They can have a dramatic effect on independence, removing the need to depend on others for getting up and going to bed.
Compared to alternative solutions such as leg-lifters, hoists, or extensive care assistance, rotating chair beds offer a comfortable, simple means of transferring to and from bed, preserving dignity at the same time as improving mobility.
While bed rest is good for recuperation, it has also been realised that patients need to be assisted to become active as early as possible. During the recovery period the patient is dependent on their own strength in combination with the help of staff to be mobilised. However, during the early stages of healing and mobilisation, when the patient is still very weak, the strain on care staff can be an occupational hazard. The standing bed, as shown here, is an effective way to mobilise patients safely, and support staff who have this responsibility: it has been precisely engineered to meet the needs of both staff and patients.
For largely immobile clients, who are at high risk of developing pressure sores, or who already have them, a pressure relief system must be integrated with any other features required of the bed.
Dynamic alternating systems consist of a mattress or overlay which is made up of individuals cells which are continuously inflated and deflated by an electrically-powered pump, so that pressure areas are regularly varied, whilst maintaining comfortable support. The mattress cover is very smooth and vapour permeable, to prevent friction, shearing (pulling) of the skin and maceration (where the skin remains damp), all of which encourage the formation of sores, and slow their healing.
This type of mattress is sometimes also combined with a lateral turning motion: the bed’s occupant is automatically turned from one side to the other at pre-programmed intervals. This feature can help minimise the work of care staff in manually turning immobile patients, and it does relieve pressure, but it is not a complete solution for everybody: for example, limbs may need repositioning manually, for comfort.
There are also mattresses made from adjustable air-filled cells which are not powered. These are adjusted manually, using a pump, and cushion the user comfortably with pressure evenly distributed, though they will not alternate pressure areas as the automatic system does. They are cost-effective and do not require a power source.
A low maintenance approach to pressure care comes in the form of mattresses and overlays made from high tech foam. The foam maintains a low temperature (which is important as raised skin temperature is another indicator for development of pressure sores), and distributes weight evenly across the supported surface. There is often a cut surface, to improve conformity to the user’s contours, and airflow, which again helps with preventing heat build-up.
Visco memory foam, which gently moulds to the shape of the user, may also be used, and many of these mattresses are made up of two or more layers of different materials, each of which contributes its own qualities. There may also be gel- or air-filled cells within the mattress.
Sectional mattresses and overlays are available to go with profiling beds.
There is more on pressure relief here.
Bed rails or Cot sides for hospital beds
Safety rails, or cot-sides, as they are also called, may be helpful to protect people from accidentally falling out of bed, but it is important that they fit properly with the bed and mattress they are used with, and that they don’t provide extra hazards, such as gaps where the user could become trapped, or impermeable surface that could cause suffocation. If an overlay is used on top of the mattress, standard bed rails may then be too low to do their job.
Soft, bumper-style bed surrounds can provide all-round protection for anyone at risk of falling, and eliminate the risks of entrapment and suffocation at the same time. It is important that the individual needs of the bed’s occupant are carefully assessed and a system provided that meet those needs.
Safety rails should never be used to try and stop someone climbing out of bed: they risk worse injury by trying to climb over them.
There is an extensive article explaining the relationship between bed rails, replacement pressure care mattresses and overlays, and the incidence of bed falls in care home environments, here.
Mattresses and bedding with waterproof covers are available, but may be unpleasant, causing excessive sweating and making a noise as the user moves in bed.
Washable or disposable bed pads, which lie on top of the sheet and absorb urine, may be more sympathetic. Some of the pressure relief mattresses also have a facility to draw urine away from the user’s body.
There is more on incontinence protection here.