With risk factors such as dementia, delirium, agitation, disorientation, limited mobility and acute illness affecting elderly patients, this puts them at a higher risk of falling from a bed. Some of these patients may have been nursed on mattresses on the floor so it’s important to understand how to best manage these situations and potentially incorporate Ultra Low Beds.
When the use of bedrails is inappropriate, consideration should be given to the use of an Ultra Low bed. However, they should not be seen as a universal falls prevention solution and provided inappropriately for mobile patients, as this could be deemed as restraint.
Ultra Low beds can reduce the risk of a fall from height, whilst allowing staff to attend to the patient, with consideration to back care.
It is important to note that even when Ultra Low Beds are used correctly in the lowest position, some patients may still sustain serious injuries such as a fractured hip or intracranial injury. As a result, it is important that even these falls are taken seriously.
Assessment for Ultra Low Beds
Patients should be assessed individually by a registered nurse or therapist to establish the most appropriate method of preventing falls from a bed.
This should include:
- Completion of the Bedrails risk assessment
- Completion of the Falls Care Plan
- Physical illness – Some medical or nursing interventions may be challenging or impractical when using an Ultra Low bed
- Psychological illness or distress – the unusual position of the bed may trigger distress, agitation or increased confusion for the patient
- Previous accidents and injuries resulting from falls – the time, place and cause of a previous fall may or may not indicate that an Ultra Low bed would reduce the patient’s risk
- Tissue viability – recent concerns have been highlighted about the compatibility of certain Ultra Low beds with some air flow mattresses.
- If the patients skin inetgrity is at risk, the assessing nurse or therpaist should consider if the Ultra low Bed available has a full profiling capability. Some Ultra Low beds do not have a ‘knee break’ i.e. they raise the patient’s legs so that their lower legs are horizontal. This then results in the patient’s sacral area sitting in a ‘V’ with undue pressure on the sacrum. If the patient’s skin integrity is at risk, a fully profiling bed should be used, allowing the patient to sit in a naturally contoured position.
- If the Ultra Low bed may cause a problem when used with certain matresses e.g it has been noted that when a patient sits on the side of the Richmond bed and compresses the standard mattress, this can result in pressure on the back of their legs. If this is the case, staff should ensure that the patient does not sit on the side of the bed for protracted periods or they should identify a more suitable mattress.
- If the bed will be compatible with a bed table as they may not fit under some Ultra low beds.
- When patients are assessed individually by a registered nurse or therapist for an ultra low bed, it would be deemed good practice to document in the patient’s notes / falls care plan that the patient has been consulted with regarding the use of the ultra low bed. Documentation should include that the patient is aware of the restrictions the ultra low bed may impose on them, but have given their consent to its use to reduce the risk of further falls and ensure their safety.
- If there are concerns that the patient may not have capacity to consent to its use, then an assessment of capacity should be made in line with the 6 steps outlined in the Guardianship and Administration Act 1993 .
- If the assessment of capacity demonstrates that the patient lacks capacity to make this decision themselves, then the multi disciplinary team should make a best interest decision also involving the patient’s next of kin.
- The outcome of the capacity assessment should also be clearly documented in the patient’s notes / falls care plan.
- Variation in cognitive status over a 24 hour period e.g. nocturnal confusion
- Disability/capability – the use of an Ultra Low bed may improve/impede the patient’s ability to transfer.
- Patient’s weight – check the weight limit for the Ultra Low bed available, as it may not be suitable for patients over a certain weight.
When using an Ultra Low bed
- Document the decision to use or not use an Ultra Low bed in the nursing notes and falls care plan. This should include the rationale and whether or not bedrails are appropriate.
- Ensure the decision is communicated to all members of the multidisciplinary team.
- The use of Ultra Low beds should be reviewed daily (on wards where alternative bed options available) and recorded.
- Ensure the Ultra Low bed is kept away from floor level furniture, doors, lockers, pipes, wheelchairs, commodes, radiators and other low level hazards to reduce the risk of personal injury to the patient.
- Ensure the Ultra Low bed is either placed flush to a wall or with a large enough gap either side, to prevent asphyxial entrapment if the patient slipped between the side of the mattress and the wall.
- When the patient is on the Ultra Low bed, the bed must be returned to the lowest level to prevent a fall from height after being attended to by staff. All staff must ensure that the bed is at it’s lowest level if the patient is left unattended.
- Staff who are unfamiliar with the patient’s current fall status should check the Inpatient Falls Care Plan and Bedrail Risk Assessment before contemplating use of the bedrails if they are attached to the bed.
- Crash mats at the side of an Ultra Low bed should be used with caution. These can cause a trip hazard for both patient and staff. When the patient is not using the Ultra Low bed e.g. sitting in an armchair, any crash mat in use should be removed from the bed area and stored safely.
- Choice of mattress to be used on the bed should be determined by assessing the patients weight, skin integrity and any risks of injury or entrapment. The assessing nurse should ensure that any air flow mattress being considered is suitable for use with the Ultra Low bed available.
- Take care when positioning the legs of a hoist under the Ultra low bed, as limitations imposed by the low height of the bed could cause a manual handling concern.
- Prior to completing any manual handling manouevre, ensure that the bed is at the correct height for the patient and staff.
With this comprehensive list, you can ensure that you know have the knowledge to affectively asses and manage patients who require the use of Ultra Low Beds.