Guideline for Assessing, Ordering and Fitting of Bed Safety Rails

Transcription

1 Guideline for Assessing, Ordering and Fitting of Bed Safety Rails POLICY NUMBER DN/GUID/012 DATE RATIFIED JULY 2007 NEXT REVIEW DATE JULY 2009 POLICY AUTHORS DN CLINICAL GUIDELINES GROUP ACCOUNTABLE EXECUTIVE DIRECTOR AND CHIEF OPERATING OFFICER OF THE COMMUNITY SERVICES UNIT RATIFYING BODY CLINICAL POLICY RATIFICATION GROUP VERSION NUMBER 2

2 GUIDELINE FOR ASSESSING, ORDERING AND FITTING OF BED SAFETY RAILS Rationale To provide information to enable qualified health professionals to effectively and safely assess, order and fit bed safety rails. Scope Any qualified health professional who has received the appropriate training and is competent and confident to undertake this procedure. Equipment Bed Rail Risk Assessment Tape measure Bed Rail Procedure ACTION 1 Assess service user, bed and environment by using Bed Rails Decision making flowchart (Appendix 1). 2 Complete Bed Rail Risk Assessment (Appendix 2). 3 Fax completed Bed Rail Risk Assessment form to Home Loans on RATIONALE To ensure Bed Rails are the most suitable option. To indicate type of equipment recommended, rationale for choice and that consent has been obtained from service user. To place order for specified rails and to enable rails to be released. 4 Bed Safety Rails will be delivered. To have rails in place. 5 Health Professional to visit following delivery to correctly position rails on the bed, completing Fitting Assessment (Appendix 2). File in service users notes 6 Review Bed safety Rails at three monthly intervals or if any changes occur with service user, mattress, bed or environment. 7 Refer to Bed safety rail Flow Chart (Appendix 3). To ensure rails are fitted in accordance with British Standards and to maintain service users safety. To ensure Bed safety rails are the best option and to ensure being used safely. To confirm correct procedure for ordering and reviewing Bed safety Rails.

3 References British Standards Document BS EN 1970; 2000 (BSI 2001) Anonymous. Critical Care Nursing Quarterly. Fredrick: Jul-Sep Vol.26, Iss. 3, Pg A Guide to Bed Safety Rails in Hospitals, Nursing Homes and Health Care: The Facts. Medical Devices Agency (2001) Advice of the Safe Use of Bed Rails. MDA DB2001 (04). National Patient Safety Agency - Safer Practice tice 17. Slips, trips and falls in hospital (2007) Medicines and Healthcare products Regulatory Agency. Device Bulletin 2006(6) Safe use of Bed Rails Medicines and Healthcare products Agency. Device Alert 2007/2009 Beds Rails and Grab Handles.

4 APPENDIX 1 Has the patient/ Family asked for bed Is the patient at risk from falling out of bed? If any hazard seems apparent, the device should not be used Is the patient unconscious or has a reduced level of Is the patient agitated of confused and likely to fall out of bed Is the bed & mattress combination appropriate for use NO Bed Rails Inappropriate Safety Checks Prior to the Use of Bed Rails Risk of entrapment & damage to limbs Risk of patient climbing over the top Ensure the bed rail is compatible with the bed frame & mattress depth Consider Psychological effect of using bed rails The supports must be fixed at the head end of the bed, not the foot end Has the environmental risk been reduced to AS SAFE as reasonably predictable? Does the patient understand the purpose of the bed Bed rails may be used with caution Does the patient understand the purpose of bed rails? NO NO Has the consultation with the patient/ family taken place? Document the Risk Assessment Process in the Clinical Records Using: Risk management guidelines Risk Assessment tool Flow chart Manual handling guidelines Bed rails may be used with caution and only with the patients informed consent. Have alternatives been discussed? Bed rails may be used with caution and with the patient s informed consent Bed rails may be used with caution and only with the patients informed consent Is the patient able to participate in decision making and give informed consent NO Order the bed rails & bumpers Bed rails may be used with caution, discuss with the family, consider alternatives Assessment Should Be Done Before ordering Following Delivery Every three months When significant condition/environment changes occur Acceptable Alternatives To Bed Rails May Include: Use of variable height bed Additional mattress on the floor Caution

5 APPENDIX 2 Bed-Rail Risk Assessment Patient Address DoB NHS Date of Assessment Assessor Signature Designation Review Date *tick as appropriate * Hazard Risk Control Measure Patient has violent/ agitated movements High Do not use bed-rail, consider repositioning bed to a lower height & fall out mattress or specialist equipment order The occupant is likely to remove the bed rail bumper High As above The patient has made previous attempt to climb over the bed High As above rails The patient is or can become agitated/ confused/ disorientated High As above Patient has impaired mobility Medium Encourage patient to call/ wait for assistance, consider referral for support (grab) handle Patient has sensory loss Medium As above Patient suffers from postural hypotension Medium As above Patient is taking medications such as narcotics and sedatives Medium Consider the use of bed-rail with bumpers or cocoon (specialist assess) There is a history of seizures Medium As above Patient has a lowered level of consciousness Medium As above Patient wriggles a lot in bed and tends to roll over Medium As above Patient has a fear of falling out of bed whilst asleep Medium As above There is a chance for the patient s arms/ legs/ neck/ head or Medium As above other part of the body to fit through the gaps in the bed rail The patient had a history of above Medium As above There is a history of self-harm Medium As above Patient has a poor sitting balance Medium As above If the patient has more than one condition, always follow the control measure with the higher risk. In all cases, adjusting the bed to the lowest possible level to minimise the risk of injury is always the first control measure to consider. Has the assessment been discussed and agreed with patient/relative always seek consent before installing a bed rail. Summary of Risk assessment: Hazard Risk Recommendations PLEASE FAX EQUIPMENT REQUESTS TO THE COMMUNITY EQUIPMENT SERVICE ON:

6 Fitting Assessment Consent and information provision Has the assessment been discussed and agreed with the user? Has the assessment been discussed and agreed with the carer? Has written guidance been provided to user/carer? Fitting & environment check Is there a gap between the lower bar of the bed rail and the top of the mattress? Does the mattress compress easily at its edge? Is there a gap between the end of the bed rail and the headboard, or wall that is outside the recommended measurements? (Distance between the end of the bedrail and headboard or wall should be between 6mm and 6cm/60mm (i.e. fingers pass through but not wrist). The gap at the foot of the bed should be equal or more than 25cm/250mm (i.e length of wrist to elbow) Is there a gap between the bed rail and the side of the mattress that will allow the occupant s body to pass through or trap their head? Is the bed rail secure does it seem likely that it will move away for the side of the bed and mattress, or fall off one end? Do the dimensions and the overall height of the mattress compromise the safety of the bed rail is an extra height bed rail needed? (Distance from the top of the mattress, when in a lying position, to the top of the bed rail should be no less than 22cm/220mm) NB: If the response to any answers above is yes there is a risk of entrapment, try to resolve the issue, if unable bed rails must be removed. Fitting Assessment completed by: Print name: Date: Signature: Designation:

7 APPENDIX 3 ASSESSMENT REQUESTED FOR BED SAFETY RAILS/REVIEW Health Bed District Nurse Assessment NHS/Trust OT Assessment Social Services OT Assessment Personal Care Consultant Assessment Complete Bed Safety Rail Assessment Tool and Fax to Loans (app 2) Complete special aids request for non stock items Delivery arranged by stores Visit by assessor to set up bed safety rails and complete fitting assessment. Written guidance provided to user/carer 3 month review Further assessment required District Nurse assessor Other assessors no Professional currently involved WBC/OT assessor PCT/District Nurse completes review WBC/OT complete review t satisfactory Satisfactory Set next 3 month review date