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A client of ours was recently involved in a near bed entrapment. This client was not in a hospital bed at the time. In fact, he had a hospital bed at his home for a short time but voluntarily discontinued use of the hospital bed, opting instead to use an adjustable bed intended for home use rather than home-care use.
Our client is an incomplete quad that was self-catheterizing while lying on a low-air-loss surface. My client is a little hazy on the details, but the air sacs of the sleep surface collapsed under him resulting in his head getting caught between the mattress and the wall (there is no headboard).
After the event, we re-instructed the client on proper use of the bed and to make sure that the sleep surface pump is at the 'full' setting to make the surface as supportive as possible during activities and transfers. We also discovered that the bed had moved away from the wall creating the space to entrap the client's head. After moving the bed back into position, we re-offered the use of the hospital bed with attached headboard that would prevent future issues.
The FDA has a great site with non-binding recommendations for manufacturers and purchasers of hospital beds to prevent entrapment. The document also outlines the testing procedures and tools needed for testing a bed for risk of entrapment. This information can be very helpful to put a nervous client at ease or investigating cause after an event. There is also a great list of other documents and brochures that can be viewed/downloaded regarding hospital bed safety.
Invacare has a brochure to download on their site that summarizes much of that information. It may be something to consider adding to your Patient Information and Education sheets.
The homecare environment does not allow us to keep an eye on our patients 100% of the time. How do you help keep your clients safe in bed?
Practice Safe Sleeping?
5 Steps To A Solid Sleep Surface [Hospital Bed Hack]
I have two clients on the Sentech Medical, Stage IV 3000 Low Air-Loss mattress on top of an Invacare fully electric Home Care bed that recently complained of lack of lumbar support stating that they could feel the springs in the bed surface. Both clients received their mattresses within a few months of each other and both have been using their mattresses for about a little more than a year. While each mattress had seen approximately the same amount of service time, the beds had been in the homes for widely varying lengths of time. These same clients had a history of complaining about their mattresses that usually turned out to be user error or the result of product misuse or neglect.
Both clients are tall and overweight males that transfer in and out of their beds performing a very hard lateral transfer from their wheelchairs using maximum assistance from an aide.
Upon inspecting the mattresses at the client's homes there was no problem with the mattresses. All the air sacs inflated properly and the mattress pumps were operating well without any alarms. I turned the alternating pressure function off on the mattresses as a test, but the clients were still complaining of pain in the lumbar region and feeling the springs.
Since the beds were working and the mattresses were working, it was time to come up with a different idea. Working off the premise that a Roho cushion works better on a solid seat than a sling seat, we decided to give the spring foundation beds a solid pan surface. Since Sunrise Medical has discontinued their Grid-Style bed, I don't have a regular supplier that provides a solid sleep surface except for bariatric sizes. A simple modification to my clients existing bed seemed like the most effective route to take:
Materials needed:
- 1 8'x4'x1/2" sheet of plywood
- 14 1 1/2 x 1/4" carriage bolts and nylock nuts
- Paint or other sealant
Tools:
- Saw
- Drill (Cordless preferred)
- Cobalt drill bits (Three sizes up to 1/4" diameter)
This is a simple modification that is pretty inexpensive and gives a good result. The following instructions are for an Invacare Fully Electric IVC bed, but should work for most of the 'clones' that are out there. The most important thing is to verify the measurements of the wood sheets so that they do not interfere with the function of the bed. We chose not to cover the head and foot portions of the bed since the majority of the patient weight is located in the trunk and leg portions of the bed.
Step 1 - Cut to size
Cut the plywood to size. The sheet will need to be cut down to 4 pieces to allow the bed surface to move and to allow the bed rails to attach at the appropriate location. Cut the following pieces:
- 34 1/4" x 15 1/2"
- 34 1/4" x 8 1/2"
- 34 1/4" x 14 1/4"
- 34 1/4" x 15 1/4"
Paint the plywood with a sealant. The clients I am working with are not incontinent
but just in case I wanted to make sure that the wood was protected as well as providing a dust and splinter free surface for the mattress to slide on. Thompson Water Seal or Kilz primer would work, but we picked up a can of 'oops' paint at Home Depot for $5.00.Step 3 - Drill holes
The individual sheets of plywood need to be secured to the frame using the carriage bolts. Take the bed outside to prevent dust and metal shavings from making a mess in your clients home. Place the sheets of plywood on the bed surface and drill your holes through the wood and the metal frame.
Take your time and use a good drill bit. The cobalt drill bits are a little more expensive but will perform the job better and faster than any of the cheaper bits. Start with a 1/8" pilot hole, move up to a medium size bit and then drill your final hole to 1/4" to match your carriage bolt. By drilling in 3 steps you will be less likely to break a bit and will not need to use cutting oil on the metal frame.
I like to drill one hole at a time and place a bolt without a nut in the hole as I move on to the next corner. By just placing the bolt in the hole I can still move the sheet around if I need to adjust placement or verify what I am drilling into under the wood.
Step 4 - Bolt it up
Once all of the sheets and the frame are pre-drilled, start bolting the wood to the frame. Tip - Bang each carriage bolt into the plywood with a hammer until the square shoulder embedded in the wood. Bolt on the nylock nuts with a socket or open ended wrench. You may have to turn the bed surface on it's side to access some of the nuts that need to be tightened. Keep in mind that the wood needs to be inside the perimeter of the bed frame to prevent tissue damage during transfers.
Step 5 - Test it out
Set the bed up in the home, attach the mattress, and test out all of the bed functions. The first time I tried this hack, I used a spade bit to drill holes in the plywood surface to allow the straps of the mattress to secure to the frame of the bed. The second time I learned that there was enough space between the plywood and the frame that I could slip the straps through without the extra holes.
Conclusion
It works. As soon as my clients lay on the new surface they noticed an immediate improvement. Considering a long history of never quite making these two clients happy, a smile and a thumbs up were all the proof I needed that the modification worked. The mods are almost a month old now and we haven't heard a single complaint.
If you need a quick and inexpensive solid sleep surface, this is a good alternative. We happened to have a sheet of plywood in the warehouse, but for the cost of paint ($5-10), bolts and nuts ($3.50ish unless you have a good junk drawer), plywood ($12-15), and some cobalt drill bits ($3.50 ea) you can upgrade a standard sleep surface to a solid pan very effectively.
