Equipment Loan Criteria for Community Nursing Reference Number:

Transcription

1 This is an official Northern Trust policy and should not be edited in any way Equipment Loan Criteria for Community Nursing Reference Number: NHSCT/11/402 Target audience: This policy is directed to all community nursing staff within the Northern Health and Social Care Trust. Sources of advice in relation to this document: Roisin McSwiggan, Tissue Viability Specialist Audrey Harris, Integrated Team Manager Doreen Bolton, Integrated Team Manager Anne McCambridge, Band 6 Nurse Replaces (if appropriate): N/A Type of Document: Directorate Specific Approved by: Roy Hamill, Assistant Director Date Approved: 1 March 2011 Date Issued by Policy Unit: 14 April 2011 (Reissued 21 Apr due to slight amendment) (Replaced on Staffnet Sept 12 due to minor updates) NHSCT Mission Statement To provide for all, the quality of service we expect for our families, and ourselves

2 Equipment Loan Criteria for Community Nursing - 2 -

3 Introduction to Policy This policy is designed to ensure that within the Northern Health and Social Care Trust equipment is supplied based on assessed need and is accessible within the agreed time frames. This process will also ensure re-assessment and retrieval of equipment where appropriate. Purpose or Aim of Policy The purpose of this document is to promote guidance on the prescribing and usage of community nursing stock and non stock equipment. Policy Statement To ensure community nurses utilise the available community equipment stock appropriately. To ensure that community nursing order non-stock equipment appropriately. To ensure that patients have timely access to appropriate equipment based on assessed need. To ensure that stock purchased within the Northern Health and Social Care Trust is in accordance with the Regional Supplies Service Contract. Where possible, stock purchased for patient use should be evidenced by a sound knowledge base. Target Audience This policy is directed to all community nursing staff within the Northern Health and Social Care Trust. Responsibilities The Assistant Director of Primary Care and Community Care for Older People s Services, Northern Health and Social Services Trust has overall responsibility for the implementation of these guidelines. The Community General Managers and Assistant Community General Managers should ensure implementation in the Community Nursing Teams within their localities

4 Legislative Competence In conjunction with these guidelines the following should be read: National Institute of Clinical Excellence (NICE, 2008) Pressure Ulcer Prevention: clinical guidelines 7 London. Northern Health and Social Care Trust (2010): Prevention and Management of Pressure Ulcers. NHSCT/10/313. Northern Health and Social Care Trust (2011) Policy on the Provision of Equipment and Adaptations for Patients and Clients in the Terminal Care phase of Illness. NHSCT/11/438. Equality, Human Rights and DDA This policy has been drawn up and reviewed in the light of Section 75 of the Northern Ireland Act (1998) which requires the Trust to have due regard to the need to promote equality of opportunity. It has been screened to identify any adverse impact on the 9 equality categories and no significant differential impacts were identified, therefore, an Equality Impact Assessment is not required. Alternative formats This document can be made available on request on disc, larger font, Braille, audiocassette and in other minority languages to meet the needs of those who are not fluent in English. Sources of Advice in Relation to this Document Roisin McSwiggan, Tissue Viability Specialist Audrey Harris, Integrated Team Manager Doreen Bolton, Integrated Team Manager Anne McCambridge, Band 6 Nurse - 4 -

5 Contents Page Introduction 6-10 Beds Chairs, Toileting, Moving and Handling items, Miscellaneous Standing Aids, Hoists and Slings Mattress Guidance 42 Cut Foam Mattress and Visco Elastic Overlay and Airwave Mattress Replacement Systems Cushions Guidance Appendices: Northern Health and Social Care Trust Equipment Form 60 Service User Information Leaflet MESaLS Step by Step Guide - Step by Step Instruction for Issue of Equipment Step by Step Instructions for Collection of Equipment Risk Assessment Form and Guidance (should only be used when staff have appropriate training) Hoist Selection 77 Prioritisation of Community Equipment Service Waiting Lists 78 References

6 Introduction NICE (2004) recommends that patient need should be assessed using an integrated approach. This is to ensure that equipment, necessary to enable patients to be cared for in the community, is accessible within an agreed time frame. Where appropriate the equipment should be removed promptly and sensitively when no longer required. Aim The purpose of this document is to provide guidance on the prescribing and use of community nursing stock and non-stock equipment. Objectives To ensure community nurses utilise the available community equipment stock appropriately. To ensure that community nursing order non-stock equipment appropriately. To ensure that patients have timely access to appropriate equipment based on assessed need. To ensure that stock purchased within the Northern Health and Social Care Trust is in accordance with the Regional Supplies Service Contract. Where possible, stock purchased for patient use should be evidenced by a sound knowledge base. Assessment In all instances patient assessment should be carried out by a Registered Nurse. Environmental factors should be considered and location of equipment within the home should form part of this assessment, to ensure effective use of resources. Requests for community equipment may be for a number of reasons including: To promote patient enablement To support activities of daily living and risk assessment Rehabilitation End of life terminal care - 6 -

7 Where possible, alternatives should be sought prior to utilising community nursing equipment. In all cases equipment will be provided for short and long term use based on assessed need. Equipment will be provided to a patient s main residence. However, it is recognised that there may be exceptional circumstances that require individual consideration. Equipment will be based on assessed need taking into consideration cultural and religious identity. Risk Assessment A risk assessment should be carried out by the most relevant person before utilisation of equipment. This should include consideration of the individual s and carer s specific needs, equipment available, environment and any other relevant factors that may affect the use of community nursing equipment. This should be clearly documented on Northern Health and Social Care Trust Risk Assessment Form (appendix 4) and disseminated to those relevant to the patient s care. Request for Equipment Community nursing staff will promptly request stock equipment via the MESaLS System. Non-stock equipment should be ordered through an Integrated Team Manager using a Northern Health and Social Care Trust non-stock requisition book and requires authorisation by a Community General Manager. Any unmet need should be documented and reported to the direct line manager. An unmet need form should be completed. Community equipment stores will hold a list of all non-stock equipment that has previously been purchased and returned to stores. Before ordering any non-stock item, staff should check with equipment stores for availability and consider all available alternatives. Nursing Home Requests Any request for equipment by a nursing home should only be considered following an individual assessment of the patient by the named worker or senior nurse. This assessment should include a consideration of the current equipment available within the nursing home and all available alternatives explored. Where a placement is being considered the named worker should in the first instance ensure it can meet the patients needs. The nursing home involved should be advised equipment will be provided only on an interim short term basis until they can access their own equipment. Where equipment is being supplied to a nursing home it should be directed via the Assistant Community General Manager for authorisation by the Assistant Director

8 This patient should be reviewed 3 monthly by the named worker to ensure equipment is still required and retrieval arranged as soon as reasonably appropriate. Confirmation of approval by Assistant Director should be recorded in the free text box at stage 4 of the MESaLS process. The approval sought beforehand and recorded in this box will improve delivery response time of CES. Residential Homes Community nursing equipment being supplied to a residential home should be based on an individual holistic assessment by the relevant Community Nurse. This equipment should be supplied on the principle of it being the patient s own home but should be authorised by the Senior Nurse within the team. The name of the nurse giving authorisation should be recorded in the free text box at stage 4 of the MESaLS process. The patient should be reviewed 3 monthly to ensure equipment is still required and retrieval arranged as soon as reasonably appropriate. Equipment Priority Priority for equipment will be given to the following patients: Hospital discharges Terminally ill patients Patients with grade 3 or 4 pressure ulcers; who require an alternating pressure relieving mattress. Delivery of Priority Request Equipment Patients who are assessed as needing priority request equipment (Hospital Discharges/Terminal Disease) will have it delivered within 24 hours Tuesday to Friday if order is received before 3.30 pm, the previous day and deliver on a Monday if received before 3.15 pm on Friday, excluding weekends and public holidays. Delivery Standard Requests for Equipment from Main Store Stock equipment is held centrally within the Trust at: Pennybridge Industrial Estate Ballymena Routine equipment is delivered normally within 3 working days from community stores if available

9 When patients receive any Trust equipment they should sign a Northern Health and Social Care Trust Equipment Form, which the person delivering will supply (appendix 1). A service user information leaflet should be provided to patients on receipt of equipment by community equipment stores (appendix 2). Changes to Location of Equipment Relocation of equipment should only occur in exceptional circumstances. This should be negotiated between Community Equipment Stores and Community Transport (Separate guidance will be issued regarding transportation and movement of equipment.) Reassessment of Equipment Patients in receipt of community nursing equipment should be reassessed on a 3 monthly basis or more frequently where indicated. This reassessment applies to all patients who have equipment supplied by community nursing even if there are no ongoing identified nursing needs. Recovery of Equipment: It is the responsibility of the community nurse to reassess and prioritise patient need in relation to equipment. It is also the responsibility of Community nursing staff to identify and arrange recovery of unused equipment. The community nurse can organise equipment retrieval through the MESaLS System. Collection of priority and urgent uplifts of equipment will be provided, where possible, in 5 working days. All recycled equipment will be cleaned and checked for reissue by the Trust Equipment Store, in accordance with the Northern Health and Social Care Trust s Infection Control Policy. Equipment beyond economic repair will be identified for disposal. However, some parts of the equipment will be kept for the repair of other similar items of equipment. Team leaders will be provided with monthly lists of patients who have been issued or are waiting for equipment from Equipment Stores. This is to assist in verification of continued patient need for equipment. Profiling beds and high-risk air fluidised mattresses will now be issued on short-term loan to promote this active cycle of reassessment. The Northern Health and Social Care Trust actively encourage this proactive approach to utilisation of equipment

10 Emergency Sub Stores with Equipment Within community nursing it is each locality s responsibility to ensure arrangements are in place for access to a designated sub store to provide in emergencies a commode, glide sheet, nebuliser and suction machine. A syringe driver should also be available as part of this emergency equipment (available from community nursing.) Further guidance on equipment sub stores for terminal care patients is detailed in the policy, Provision of Equipment and Adaptations for Patients and Clients in the Terminal Care Phase of Illness (Northern Health and Social Care Trust, 2011). It is the responsibility of the community nursing teams in each area to replenish this equipment. This is replenished thorough the MESaLS System, by using the patient s details for whom the equipment was supplied. Occupational therapy will maintain their own sub stores

11 BEDS

12 Equipment Description Criteria for Issue General Considerations/Precautions Lower Entry Bed profiling bed (TLE146N) Electric powered. Head, foot and height adjustable. 8 inches/20 cm from ground. Patient and carer hand controls. 3ft wide. Maximum patient weight 24 stones or 150kg. For clients of smaller stature whose own bed or standard profiling bed is too high for access. Should only be provided to nursing home in exceptional circumstances. For clients at risk of falls. Review 3 monthly. Maximum weight 175kgs. Patients over 24stones refer to bariatric bed. Clients at risk of falling out of bed may be nursed on low entry bed. However this must be risk assessed, taking into consideration height of patient, height of bed and height of the carers. Screws on bed must be checked for tightness weekly. (See separate guidance issued by Northern Health and Social Care Trust) Combined safe working load with mattress and cover is 175 kgs. Remember to consider depth of mattress with height of bed

13 Equipment Description Criteria for Issue General Considerations/Precautions Profiling Bed with Cot Sides and monkey pole TLE 142NA Electric powered. Head, foot and height adjustable. Patient hand controls. 40 cm/16 inches from ground. Patients with progressive illness requiring care or nursing intervention in bed or requiring assistance to maintain independence. Should be kept under 3 monthly nursing review. Maximum weight 175kgs/24 stone. For patients above this see bariatric bed. Clients at risk of falling out of bed may be nursed on low entry bed. However this must be risk assessed, taking into consideration height of patient, height of bed and height of the carers Should only be provided to nursing homes in exceptional circumstances. Screws on bed must be checked for tightness weekly. (see above) Combined safe working load with mattress and cover is 175 kgs. Remember to consider depth of mattress with height of bed

14 Equipment Description Criteria for Issue General Considerations/Precautions Variable Height Bed (Hydraulic Type) not profiling (TLK247N). Limited stock please contact stores before ordering. Variable height bed with foot pump and manually adjustable back rest. 3ft wide. 16 from ground 40 cm. Should be provided to nursing homes instead of electric profiling bed except in special circumstances. In the domiciliary setting it Should be provided as an interim measure if an electric profiling bed is not available. Remember to consider depth of mattress with height of bed. Weight restriction 24 stones. Use for clients who have no electricity supply Should be kept under 3 monthly nursing reviews. Can be used for patients who require minimal repositioning

15 Equipment Description Criteria for Issue General Considerations/Precautions Octave Bariatric Bed Invacare OCT1 Requires Mattress Dynamic Altair TLK225N John Preston &co Bed Rail for Variable Height bed (TLK 025N) Bed Rail for Divan Bed (TLQ008N) Electric powered. Head foot and height adjustable. Cot sides and lifting pole incorporated. Only for use with Octave bed. Full length safety rail. ¾ length safety rail. Maximum client weight 380kgs (60 stone). 4 ft wide base.7ft Long Mattress alternating system high risk. Weight as above. Only for patients who are at risk of falling out of bed. Criteria for clients who wish to remain in their own divan bed. There will be excess stretching for staff due to increased width of bed. Initial risk assessment of environment should be carried out prior to delivery of equipment by Community staff and Community Equipment. Only suitable for ground floor living arrangements. Authorisation by Community General Manager. Should be only ordered when risk assessment of potential entrapment has been made. Northern Trust Bed Rail policy is being developed Should be only ordered when risk assessment of potential entrapment has been made. Northern Trust Bed Rail policy is being developed

16 Equipment Description Criteria for Issue General Considerations/Precautions Free standing over For client who does not Check sufficient clearance for lift to fit under head bar with need or want a profiling bed. bed. handle to promote Safe working load 18 stones. patient independence. Monkey Pole Freestanding (TLM005N) Penryn Lifter Non stock but check stores availability Can be used for clients in their own bed. Will impede use of hoist. Bed Extensions (TLE145N) Contact stores before ordering Extension to profiling bed. Longer length for taller patients. Pentaflex foam (TLE0955) insert must be ordered to accompany extension. If pressure relieving mattress is being used pentaflex block goes to head of bed. Bed Rail Bumpers (TLK096N) Contact stores before ordering For those clients at risk of entrapment. ¾ length cot sides. Consider type of bed and length of rail. Bed Rail Bumpers (TLK095N) Contact stores before ordering For full length bed rails. For those clients at risk of entrapment. Consider type of bed and length of rail

17 CHAIRS, TOILETING, MOVING AND HANDLING ITEMS, MISCELLANEOUS

18 Equipment Description Criteria for Issue General Considerations/Precautions C15 Powered Recliner (REC1) Wipeable, electric powered chair with adjustable reclining positions. Palliative/terminally ill clients only who do not require pressure relief. To promote comfort. Weight restriction 147 kg (23 Stone). Clients being hoisted should not be in a recliner chair. An Integrated Team Manager or Senior Nurse Practitioner s authorisation is required before staff instigate requisition. Please indicate in free text box on MESaLS name of Manager giving authorisation. Patients requiring chairs for functional mobility should be redirected to Occupational Therapy for assessment. Heavy Duty Version (RECH/D) As Above Weight Restriction 170kg (27stone) Raiser Recliner with Pressure Relief (RECPRES) Not on contract Turntable Disc anti-slip (Pediturn) (GJJ559N) Handling Belt Large(GJJ647N)/Small size(gjj647n)/medium size(fdn118n Wipeable, electric powered chair with adjustable reclining positions. Integral pressure relief Turning disc wipeable cover. Padded belt with buckle and hand loops to assist transfers. Fits around waist. Palliative or terminal care patients who require pressure reliving seating. To assist patients to transfer close distances/pivot transfer. Patient requires assistance to transfer or mobilise. Not on contract contact stores before ordering If none available will require CGM approval to order specific cushion separately to be attached to RECH/D chair. A risk assessment should be carried out before using equipment. Not suitable for patients who would step off disc. Weight consideration 190 kgs. Ensure sufficient turning space for use of equipment. A risk assessment should be completed before use. Ensure correct size used for individual needs

19 Equipment Description Criteria for Issue General Considerations/Precautions Mobi-lite Sheet (FVG065N) Washable full bed length transfer sheet. Bed Cradle (TLM 240C) Fits under mattress. Metal tubular frame. For patients in terminal phase of illness to assist repositioning in bed. For patients unable to tolerate weight of bedding on lower limbs. A risk assessment should be carried out before use. The mobi-lite should be used white side up normally but yellow side upwards for incontinent patients. Available as limited stock check with stores for availability. A risk assessment should be carried out prior to use. Bed cradle should not be used with certain electric profiling beds. Multi Glide Sheet 80cm x 110cm (FVG030C) Anti-friction sheet suitable for positioning the client in bed or for transferring in and out of bed. For patients requiring assistance to carry out transfer or repositioning in bed. Ensure adequate clearance between limb and frame when in use. A risk assessment should be completed prior to use. Glide sheet should be removed safely after use. Ensure appropriate manual handling techniques utilised with use of glide sheet

20 Equipment Description Criteria for Issue General Considerations/Precautions Commode Mayfair (TSF220C) Metal frame commode wheeled with brakes and removable arms. For patients with reduced mobility requiring assistance with toileting. Weight 154 kgs. Transfers should be kept to a minimum using the commode. Patients should be able to raise their feet clear of the ground and keep arms close to body during transfers to avoid injury. Ensure environment is clear of obstacles to facilitate transfers. Wide Mayfair 22 inch Commode (TSF 151N) Static Commode (TSF210C) Metal frame commode wheeled with brakes and removable arms. Static commode (brown in colour). As above ensuring appropriate weight requirements. For patients who are mobile and cannot access standard home toilet facilities. Ensure a risk assessment has been carried out prior to use of equipment. 30 stone 190 kgs. Ensure patients are aware the commode is light as it has the potential risk of over balancing. NB a soft seat padded version is available, check with stores for stock availability

21 Equipment Description Criteria for Issue General Considerations/Precautions Bariatric Commode Non stock purchase at present. Pan Commode Round (Commode pot) (TSF212C) Bed pans check with stores Female urinal Bed pan Available as limited stock. Check with stores for availability. Hard plastic bedpans, reusable single client use. For patients who are not suitable for 22 Mayfair commode. Replacement commode pot for static tubular commode. For those patients requiring toileting in bed. Male Urinal Available on individual Bed Side Table (TSW070N) stock requisition. Available if existing stock allows. Not being replaced by Community Equipment Stores. Ordered via Assistant Community General Manager. Check stores for any current available stock Can only be ordered for static commode TSF210C. Order via CSA Order via CSA

22 Equipment Description Criteria for Issue General Considerations/Precautions Foam Wedge (VQB050C) Foam pillow support. For patients who need to be nursed in an upright position. Should not be used on a profiling bed. Single use only. One Way Glide (FVG033C) 3 sizes available wheelchair/chair/bed. Glide sheet with Velcro strips to allow backward movement but prevent forward slipping. Should be used with patients own bed. To prevent patient slipping forward in chair. Can be used over pressure relieving cushion except Roho. This will reduce pressure relieving properties therefore skin should be monitored closely. Bed 280x50x300 mm Chair 180x50 mm Wheelchair size ordered via Occupational Therapy A risk assessment should be carried out prior to use. Arrow should always point towards back of chair

23 Equipment Description Criteria for Issue General Considerations/Precautions Suction Machines Lateral portable suction machine (FDR037N) Blue case suction machine. Electrically powered and battery backup. For patients who have had a nursing/medical assessment as requiring suction at home. For patients who are mobile, require suction outside patients home. Full training should be given to user by requisitioning professional. Suction Machine Sam 12 Mains electric (FDR356N) Glass bottled suction machine. Mains electric operated. For patients who have had a nursing/medical assessment as requiring suction at home. Suitable for patients who are housebound. Ensure patient has a battery powered suction machine incase of electricity failure. Full training should be given to user by requisitioning professional. There is limited stock of suction machines

24 Equipment Description Criteria for Issue General Considerations/Precautions Etac Turner Non stock available only if existing stock. Stores will advise of code if one available Safe working load 150 kgs. Client has ability to sit to stand with/without assistance but have difficulty in turning. Counter pressure must be applied to foot plate while client performing sit to stand and vice versa. Only suitable for turning clients, they cannot be transported on it. Environmental assessment is required to ensure seating for transfer is suitably positioned

25 Equipment Description Criteria for Issue General Considerations/Precautions Arjo Stedy (GTF226N) Limited availability item Please check with stores before ordering Non mechanical stand aid. Safe working load 120 kgs (18 stone). For clients with weight bearing ability. Clients must be able to assist in sit to stand transfer. Client has limited lower limb strength and balance. Client requires aid for transportation. Safe working load may be limited by patient s hip width. Client must be able to stand fairly upright to allow seat paddles to be closed. Fixed legs on Stedy may restrict access to seating or toileting. Patients with poor trunk control will require a support belt, which should be ordered separately. Not suitable for use in shower. An assessment of the environment should be carried out prior to use especially focusing on space, door saddle boards and flooring. If fixed legs or seat paddle design legs or seat paddle design cause a problem consider trial of Quickmove

26 Equipment Description Criteria for Issue General Considerations/Precautions Quick Move Non stock item Special purchase however check with stores if any available in stock Non mechanical stand aid. Adjustable legs and seating paddles move from side position. Safe working load 170kg (27 stone). For clients with weight bearing ability. Clients must be able to assist in sit to stand transfer. Client has limited lower limb strength and balance. Adjustable legs, therefore more compatible with seating than Arjo Stedy. Seat paddles can be used from side, therefore suitable for clients unable to fully stand. Dependant on chair arm position. Risk of finger entrapment when operating seat paddles. Client requires aid for transportation. A separate back support belt is available. Suitable for use in shower where a risk assessment has been completed. This item is currently a special order and should be directed via Assistant General Manager. Check with stores if any stock has been returned that may be utilised. Staff should, prior to presenting to Assistant General Manager obtain costings for same. Available currently from John Preston & Co

27 Equipment Description Criteria for Issue General Considerations/Precautions Mechanical Stand Aids Sabina (FDN291N) Existing stock only available Mechanical stand aid. Safe working load 32 stone. Client able to weight bear but requires a lot of assistance to obtain standing position, or unpredictable when standing. Carer must be able to demonstrate proficiency in use of equipment. Moving and Handling risk assessment should be carried out where required. Access required beneath bed ie not suitable for divan bed. The environment has sufficient space to allow for the piece of equipment. A variety of slings are available. Please seek advice from Back Care

28 Equipment Description Criteria for Issue General Considerations/Precautions Mechanical Stand Aid Arjo Sara 3000 Check available stock Mechanical stand aid. Safe working load 32 stone. Client able to weight bear but requires a lot of assistance to obtain standing position, or unpredictable when standing. Carer must be able to demonstrate proficiency in use of equipment. Moving and Handling risk assessment should be carried out where required. Access required beneath bed ie not suitable for divan bed. The environment has sufficient space to allow for the piece of equipment. Currently this item is a special order and should be directed via Assistant Community General Manager. Please obtain costings prior to this

29 Equipment Description Criteria for Issue General Considerations/Precautions Sling Arjo Toileting Extra Large GKN081N Large HCT 115 Medium GKN037N Small HCT134 Limited stock check with stores before ordering Toilet sling with head support padded with clip attachments. Requires patient to have upper body strength and sitting balance. Patient should be able to follow instructions and behaviour should be predictable. Requires careful assessment prior to use. Only for use with Arjo hoists eg Trixie. Not suitable for lifting clients from floor. Not suitable for above knee amputee patients. Patients should be hoisted from upright and seated position (using adjustable bed to aid positioning). Should consider all specifications for use of Trixie hoist

30 Equipment Description Criteria for Issue General Considerations/Precautions Sling Arjo Transfer Extra large FDN313C Large FDN649C Medium FDN141N Small HCT135 Non stock Transfer sling with clip attachment and head support. Client requiring hoisting as unable to weight bear. Only for use with Arjo hoist eg Trixie. Unsuitable for above knee amputation patients. If toilet sling unsuitable the patient may be hoisted to the bed with this sling and clothing removed there prior to hoisting onto the commode. Unsuitable for clients with lower limb contractures. Suitable for majority of patients. Should consider specifications for use of Trixie hoist

31 Equipment Description Criteria for Issue General Considerations/Precautions Sling Promed Toileting with clip attachments Large FDN387N Medium FDN346N Toilet sling for Elf or Delta hoist with pivot frame, clip attachments. No head support. Requires patient to have upper body strength and sitting balance. Strap needs to be buckled around frame (see diagram on sling). Only for use on Elf and Delta hoist with pivot frame. Unsuitable for above knee amputation patients. Unsuitable for clients with lower limb contractures. For more supportive toilet slings contact Back Care Department

32 Equipment Description Criteria for Issue General Considerations/Precautions Sling Promed Toileting with loop attachments Large FDN225N Medium FDN271C Toilet sling for use on any hoist with hanger bar, loop attachments No head support. Requires patient to have upper body strength and sitting balance. No head support. Leg pieces should be crossed over through shortest loop. For use on any hoist with hanger bar. Unsuitable for above knee amputation patients. Unsuitable for clients with lower limb contractures. For more supportive toilet slings contact Back Care Department

33 Equipment Description Criteria for Issue General Considerations/Precautions Sling Promed transfer with loop attachment no head support Transfer sling for use with any loop attachment hoist. Patient must have head control Not suitable for patients with above knee amputation or poor head control. Large FSN353C Medium FSN352C Sling Promed transfer with loop attachment with head support Transfer sling for use with any loop attachment hoist Client requires hoisting as unable to weight bear. Suitable for majority of patients. Not suitable for patients with above knee amputation. Large FDN648CS Medium FDN702C

34 Equipment Description Criteria for Issue General Considerations/Precautions Sling Oxford Toileting with loop attachments Large GKN036N Medium HCT035 Small FGK114N Toilet sling for use on any loop attachment hoist. No head support Requires patient to have upper body strength and sitting balance. No head support Leg pieces should be crossed over through shortest loop. For use on any hoist with hanger bar. Limited stock Unsuitable for above knee amputation patients. Unsuitable for patients with lower limb contractures

35 Equipment Description Criteria for Issue General Considerations/Precautions Sling Oxford Transfer Loop Attachment Large FDN090N Medium FDN053N Small HCT079 Transfer sling suitable for use with any loop attachment hoist. Patient requires hoisting as unable to weight bear Suitable for the majority of patients. Not suitable for patients with above knee amputation. Limited stock Sling Oxford Transfer Deluxe Large HCT141 Medium FDN038N Limited stock Sling Sabina high back Large GJJ99N2 Medium FDN482NA Transfer sling for use with any loop attachment hoist. Extra straps at hips provide additional support. Patient requires hoisting as unable to weight bear. Suitable for patients requiring extra support or comfort around the hips. User must be competent in use and ensure carers are familiar with instructions. Standing sling. For use with Sabina hoist. Due to tightening around chest wall this sling may not be suitable for someone with chest trauma, breathing difficulty or a pot-bellied shape. Consider Sara 3000 standard

36 Equipment Description Criteria for Issue General Considerations/Precautions Hoist Promed Elf with Hanger Bar (FDN181N) SWL 127 kgs (20 stone). Powered mobile hoist with hanger bar for loop attachment sling. Client unable to perform standing transfer. Newer Elf s have under leg opening and can accommodate wider seating. These hoists have squared legs. Not suitable for taller or heavier patients. Please see Delta hoist. Suitable for any loop attachment sling. If sling positioning difficult to achieve, the client has extensor spasms or the leg pieces tighten around the groin area, consider Elf pivot frame. If not available consider Mini Oxford. Hoist Promed Elf with Pivot Frame (FDN247N) and (FDN181N) Powered mobile hoist with pivot frame for clip attachment sling. Safe working load 127 kgs (20 stone). Client unable to perform standing transfer. Sling must be compatible ie Promed or seek advice from Back Care Co-ordinator. Not suitable for taller patients see Delta hoist with pivot frame. Suitable for patients with neurological conditions where leg positioning is difficult. Newer Elf s have wider leg opening and can accommodate wider seating. These hoists have wider legs

37 Equipment Description Criteria for Issue General Considerations/Precautions Hoist Promed Delta with With hanger bar Powered mobile hoist with hanger bar for loop attachment sling. Client unable to perform standing transfer. Suitable for any loop attachment sling. Suitable for taller/heavier patients. Wider leg opening than Elf. (FDN 337C) Safe working load 150 kgs (23.5 stone). Due to larger frame may not be suitable for smaller environments. Hoist Delta Promed with Pivot Frame (FDN227C and FDN247N) Mobile powered hoist with pivot frame for clip attachment sling. Safe working Load 150 kgs (23.5 stone). Client unable to perform standing transfer. Sling must be compatible ie. Promed or seek advice from Back Care Co-ordinator. Suitable for heavier/taller patients. Suitable for neurological conditions. Wider leg opening than Elf. Due to larger frame may not be suitable for smaller environments. Please note if required phone Back Care staff who will give advice on selection of amputee slings. Community equipment holds a limited stock of same

38 Equipment Description Criteria for Issue General Considerations/Precautions Hoist Invacare IPL150 (FDN111N) Non stock only available if existing stock Powered mobile hoist with hanger bar for loop attachment sling. Safe working load 150kgs (23.5 stone) Client unable to perform standing transfer. Only use if Delta hoist not available. Suitable for any loop attachment sling. If need to use clip sling discuss with CES as needs longer bar. Suitable for taller/heavier patients. Wider leg opening than Elf Due to larger frame may not be suitable for smaller environments. Hoist Oxford Mini Hydraulic Manual mobile hoist with hanger bar for loop attachment sling. Client unable to perform standing transfer. Only to be used if no powered hoist available or in any situation where no charging of the battery is required. FDN 452N Safe working load 125 kgs (19.5 stone). Can use if no Elf available. Suitable for any loop attachment sling. Not available with pivot frame

39 Equipment Description Criteria for Issue General Considerations/Precautions Hoist Oxford Mini Electric Powered mobile hoist with hanger bar for loop attachment sling Client unable to perform standing transfer Only to be used if Elf hoist not available. Suitable for any loop attachment sling. (FDN036N) Non stock. Only available if existing stock Safe working load 125 kgs (20 stone). Hoist Oxford Major Hydraulic Manual mobile hoist with hanger bar for loop attachment sling. Client unable to perform standing transfer. Only to be used if no powered hoist available or in any situation where no charging of the battery is required. (FDN 001N) Safe working load 175 kgs (27.5 stone). Can be used if Delta Hoist is not available. Suitable for any loop attachment sling. Hoist Oxford Major electric Powered mobile hoist with hanger bar for loop attachment sling. Client unable to perform standing transfer. Suitable for any loop attachment sling. Suitable for heavier patients. (FDN 037N) Safe working load 175kgs (27.5 stone)

40 Equipment Description Criteria for Issue General Considerations/Precautions Arjo Trixie (FDN415C) Powered mobile hoist with pivot frame and clip sling. Client unable to perform standing transfer. Should only be used for patients preferably under 12 stone due to difficulty in achieving seating position using pivot frame. Non stock available only if existing stock Adjustable legs operational via foot pedal. Foldable hoist. Due to close proximity of cross bar not suitable for patients with poor head control or Kyphosis (curvature) of the spine. Safe working load120 kgs (18 stone). Not suitable for patients prone to severe spasms. Not for tall or stooped patients. Eva Hoist (FDN113N) Powered mobile hoist. Suitable for use with any loop attachment sling. Client unable to perform standing transfer. Suitable for any loop attachment sling. Lightweight frame. Longer length legs which aids turning. Safe working load 180 kgs. 3 height settings to give greater clearance. Due to longer length of hoist legs, consider environmental suitability

41 Moving and Handling Equipment The requisitioner should ensure that family/carer is able to demonstrate proficiency in use of equipment. A moving and handling risk assessment should be carried out where required by the most appropriate professional. An environmental assessment should be included to ensure sufficient space and suitability for the piece of equipment. Tracking hoists and slings are provided by occupational therapy and will be risk assessed by them. Consider Estates and Facilities Alert EFA/2010/006 Risk of Self Harm associated with Patient Hoists and Profiling Beds. Hoists should be stored away from the patient and not in general access areas. They should be stored with pivot frame/hanger bar at its lowest point. Where feasible the battery should be removed when not in use. Batteries Hoists where the battery stays attached for charging ensure red stop button not engaged as prevents charging. Where the battery is removed and placed in a charging bracket ensure socket plug remains on for duration of charge otherwise it will drain the battery. Newer models will have mains lead attached to hoist for direct charging. General Considerations with use of Hoist Slings Machine washable, check labels/follow infection control guidelines. Avoid high temperature tumble drying. Sling must be checked for signs of wear and tear prior to every use. If any defects are noted these must be reported and the sling replaced immediately

42 MATTRESSES Prevention All vulnerable patients including those with grade 1-2 pressure ulcers should, as a minimum provision, be provided with a high specification foam mattress. The ulcer should be closely observed for deterioration (NICE 2005). Patients with a grade 3-4 pressure ulcer should have an alternating pressure relieving overlay or alternating mattress replacement system. Safety Use of Mattress Ensure mattress does not elevate patient to an unsafe height. Patient should be within the recommended weight range for the mattress. Ensure risk assessment carried out prior to use of bed rails due to risk of entrapment. Manually Checking a Mattress Open zips and inspect the interior of the mattress for bottoming out or damaged cells. If the mattress cover is breached and the interior of the mattress is visibly soiled or damaged then consider changing the mattress. If the foam visco elastic or alternating mattress system interior is soiled, wet or has an offensive smell then consider changing the mattress. Maintenance of all equipment should be carried out in accordance with the Northern Health Social Care Trust Equipment and Maintenance Policy. Review High specification equipment such as profiling beds and airwave mattresses should be ordered as short term and reviewed on a 3 monthly basis or earlier as patient s condition dictates. Where the equipment requires a Senior Nurses Band 6/7 authorisation this should be sought before ordering and his/her name should be indicated in the special instructions free text box at stage four of the MESaLS requisitioning process. Remaining equipment should be reviewed on a 3 monthly basis or earlier as patient need indicates

43 CUT FOAM MATTRESS AND VISCO ELASTIC

44 Equipment Description Criteria for Issue General Considerations/Precautions Mattress Pentaflex (TLE095N) Cut foam Mattress Pentaflex Overlay Cut Foam (TLK090N) Limited being replaced. Replacement system. Depth inch overlay. For use on top of patient s own mattress. Grade 1-2 pressure ulcers. Grade 1-2 pressure ulcers. Maximum weight restriction 150 kgs/330lbs. Water resistant. Suitable for profiling bed. Can accommodate CPR. Turning guide on all mattresses. Can accommodate CPR. Conform Memory Foam Single Secures with straps. Mattress replacement. Depth 6 inches. Grade 1-2 pressure ulcers. 150 kgs/330 lbs weight restriction. (MATT1) Visco elastic (Replacing Comflex) Mattress Double Overlay Comflex 4 6 Visco Elastic code Overlay Grade 1-2 pressure ulcers. Limited stock. For use on client s own bed and mattress

45 Equipment Description Criteria for Issue General Considerations/Precautions Kaymed Double Overlay Mattress causeway Overlay mattress. Grade 1-2 pressure ulcers. Limited stock. For use on client s own bed and mattress. (VQP036N) Visco Elastic 2 inch Foam Mattress Underlay 2 Inch depth For use underneath overlay systems. To facilitate overlay mattress system. Not for pressure relief. To be used underneath alternating system. (VQP044N) Kaymed Single Mattress Visco Elastic Wheelchair Services. Mattress replacement. Grade 1-2 pressure ulcers. Minimal stock order as existing stock allows. (TLE081N) Depth 6 inches

46 OVERLAY AIRWAVE MATTRESS SYSTEM

47 Equipment Description Criteria for Issue General Considerations/Precautions Auto-Excel Air Mattress and Generator (TLE043N) Overlay Mattress Arjo Huntleigh CPR release deflates within 15 seconds. Alternating system 336 x 310 mm For use with 2 foam underlay VQP044N. High risk up to grade 3 pressure ulcer. Maximum weight 230 kgs. Suitable for profiling bed. Alpha x cell (VQM071N) Overlay Mattress Huntleigh Healthcare Ltd. Use with 2 foam underlay. 128 x 270 x 162 mm For use with 2 foam underlay VQPO44N. High risk up to grade 3 pressure ulcer. 140 kgs (22 stone) weight restriction. Adjustable to patient s weight. Weight indicator and audible and visual alarms. User guide on mattress pump. Adjustable Velcro straps to secure to hospital/profiling bed

48 Equipment Description Criteria for Issue General Considerations/Precautions Alpha Trancell Airwave overlay mattress (VQMO90N) Huntleigh 204 x 86 x 17.2 cm Manual pressure control with easy to use in numbered settings. Grade 2 to 3 pressure damage as per manufacturer s recommendations. For use with 2 foam underlay VQPO44N. 120 kgs weight restriction Cover durable polyurethane material. Check cover for rips or damage. Security straps. Easy to use guide on pump. Inspect interior of mattress. If cover torn and is visibly soiled or has an odour then send for decontamination

49 AIRWAVE MATTRESS REPLACEMENT SYSTEMS

50 Equipment Description Criteria for Issue General Considerations/Precautions Trinova Mattress Replacement CODE (TLE085N) Pegasus Ltd Mattress replacement system. Has a specific sacral and heel area in mattress mm x 800 x 210 Grade 3-4 pressure ulcers. High risk clients. 254 kgs (40 stone) weight restriction. Open cover and check cells for damage. Replace mattress if any damage present. Audible and visual alarms. CPR mode for quick deflation. Supplied with cushion for pressure relief system. Requires Band 7 nurse or ITM authorisation. Please indicate authorisation in free text box on MESALS

51 Equipment Description Criteria for Issue General Considerations/Precautions High Risk Alternating System (TLK087N) Pegasus Cairwave Pegasus Replacement Mattress 1930 mm x 880 x 210. Remains inflated for 24 hours. 10 second deflation for CPR High risk patients with grade 3-4 pressure ulcers. 630 lbs/45 stone weight restriction. Requires profiling bed or hospital bed. Requires Band 7 Senior nurse/ ITM authorisation. Please indicate authorisation in free text box on MESALS. Static mode for 30 mins to allow for nursing procedures. Audible visual alarms. Mattress Pegasus Biwave Dynamic Flotation Mattress replacement system (TLK144N) Pegasus, Arjo. Replacement mattress. In event of power failure remains inflated for at least 24 hours. High risk patients with grade 3 pressure ulcers. Requires profiling bed 222 kgs (35 stone) weight restriction. System automatically adjusts to patient s weight and position. Requires Band 7 Senior nurse/ ITM authorisation

52 Equipment Description Criteria for Issue General Considerations/Precautions Auto logic 200 Mattress Replacement Huntleigh Mattress replacement. Grade 3 to 4 pressure damage. Issued as a system with autologic cushion. (TLE090N) 2030mm x 205 x 860 Adjusts to patient s weight. Requires Band 7 Senior nurse/ ITM authorisation. Please indicate authorisation in free text box on MESALS. Battery lasts up to 12 hours. Deflates in 10 seconds. Lever at head of bed. Breeze low air loss mattress replacement Limited stock Straps to bed. Huntleigh. Mattress replacement. Height inflated mm x 866 mm. Deflates in 10 seconds. Hook and loop fastening. Instructions on pump. Very high risk patients or with existing tissue damage. Patient s who cannot tolerate alternating systems or gross leg oedema. Grade 3 to 4 pressure damage 140 kgs/22 stone weight restriction. Water resistant easy to clean, completely removal cover. Function lock out feature. 3 modes: static, pulsate, auto. Suitable for hospital or profiling bed

53 Equipment Description Criteria for Issue General Considerations/Precautions Nimbus 2/3 (TLK083N) Mattress replacement Huntleigh Healthcare Ltd Mattress replacement x 89 x 21.5 cm Soft firm setting for patients comfort. Very high risk pressure ulcers grade 3 to 4. Requires band 7 nurse/itm authorisation. Please indicate authorisation in free text box on MESALS. 250 kgs/39 stones weight restriction. Suitable for profiling bed. Check cells and cover for damage. No user guide on mattress. Velcro fastened. Deflates torso section in less than 10 seconds

54 CUSHIONS

55 CUSHIONS The highest incidence of pressure ulcers occur on the sacrum mostly due to poor posture, caused mainly by sliding down in a chair. This is caused by the seating being too deep or an incorrect angle of the back support. When assessing for any cushion the chair must also be considered. Patients should sit with their thighs level with their knees to avoid unequal pressure distribution over ischial tuberosities. This can be checked by looking from a side view that patient s knees are higher than their hips. A risk assessment should be completed for supply of any pressure relieving cushion by a trained nurse and documented in the patient s notes. (Refer to Pressure Ulcer Policy/Braden Risk Assessment Tool Northern Health and Social Care Trust 2009). The assessment should consider the following: Ensure patient s feet are comfortably on the floor and there is approximately 2.5 cm (2 finger widths) clearance behind their knees in relation to the chair. Ensure adequate clearance at each side of patient s thighs. This can be checked by placing a hand at their side, fingers together and thumbs facing forward. The depth of the chair and cushion should not raise the patient above the height of the chair arms. Pressure relieving cushions should not be used on raiser recliner chairs. Ensure the cushion is positioned as per manufacturer s instructions. Patient comfort and individual preference should be considered in all cases. The cushion if easily flattened between the fingers or appears banana shaped when not being used should be replaced. Reassessment of the equipment should occur if there is a significant change in the patient s condition

56 Equipment Description Criteria for Issue General Considerations/Precautions Auto Logic 200 Cushion for replacement system (TLE090N) Huntleigh. 410 cm x 455 x 50 Self setting settings. Battery lasts 8 hours. High Risk Grade pressure ulcers. Requires Band 7 nurse/itm authorisation. Please indicate authorisation in free text box on MESALS. 150 kgs, adjusts to patient s weight. Straps to chair. Ensure mattress cover and cells are checked for any damage. Cushion Flotech Solution CNFCI High Risk Foam Flotech 17x17x3 Grade 1 2 pressure ulcers. Weight 140 kgs 22 stone weight restriction. Chair use only