Prescriber Manual Beds and Mattresses
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Prescriber Manual
Beds and
Mattresses
A Manual devised by the SWEP
Clinical Advisory Team to assist
SWEP registered prescribers
Acknowledgments for information and use of images go to:
Independent Living Centre; Endeavour Industries; Yooralla AT Learning
Table of Contents
Background 3
Summary of Evidence 3
Recommended Assessments and Measures 3
1. OT Assessments/Bed Assessments ..................................................................... 3
2. Entrapment............................................................................................................ 4
3. Restraint and seclusion ......................................................................................... 5
4. Pressure care considerations ................................................................................ 5
5. Clinical risk assessment and pressure injury risk assessment scales .................. 6
6. Trials: Testing the user on the mattress and the bed ............................................ 6
7. Equipment: Product review ................................................................................... 6
8. Considerations for Non Standard body size bed users, including children ........... 7
9. Sleep behaviour of a bed user .............................................................................. 7
10. Relevant Characteristic Considerations .............................................................. 7
Relevant bed user characteristics .................................................................... 7
Relevant support person characteristics .......................................................... 8
Relevant characteristics in the environment .................................................... 8
Relevant equipment considerations ................................................................. 8
Description of Equipment 10
A. BA - Beds 10
BA1A - High/Low ............................................................................................ 10
BA4A - Low to floor bed ................................................................................. 11
BA4A1 - Column bed ..................................................................................... 11
BA4A2 - Trendelenberg function.................................................................... 12
BA2A - Self Help Pole ................................................................................... 13
BA2B - Bed blocks......................................................................................... 13
BA5A - Bed stick/pole .................................................................................... 14
BA10A - Bed rails .......................................................................................... 15
BA10B - Rail protectors ................................................................................. 16
BA10C - Sleep systems for pressure care .................................................... 16
Additional Non-funded items .......................................................................... 17
B. Mattresses 19
BA3 A&B - Basic Mattress—Pressure Redistribution (PR) ............................ 19
BA6 - PR Mattress Replacement (non-powered) ........................................... 20
BA7 - PR Mattress Overlay ............................................................................ 21
BA8 - Other Pressure Ulcer prevention items ................................................ 21
BA11 - Full PR Mattress replacement ........................................................... 22
References, Further Readings and Resource Links 23
Bibliography of current articles and standards.................................................. 23
Appendix 1 - Scope: Occupational Therapy Assessment for Bed Systems Safety . 26
Appendix 2 - Pressure Redistribution Mattresses and Overlays ............................. 38
Appendix 3 - Pressure Redistribution Support Surfaces Checklist.......................... 57
2
Acknowledgments for information and use of images go to:
Independent Living Centre; Endeavour Industries; Yooralla AT Learning
Background
To enhance prescription capability among prescribers, the SWEP Clinical Advisors
have developed a resource manual to provide links to evidence, recommended
assessments and measures, potential risks related to client, support person and
environment, and links to a range of product types.
Summary of evidence
Incidents have been reported that ‘patients’ have been injured by having their head,
neck or chest caught in bed rails (cot sides, bed side rails or safety rails) causing
minor injuries (abrasions) to major injury or death (partial to complete restriction of
respiration) to the ‘patient’. (Powell-Cope, et al)
It is important for the safety of the bed users, and those who care for them, to
consider safer bed ‘set up’ so that when any extra item(s) are added to the basic
bed frame and mattress, there is clinical justification for these ‘extra items’ and all
areas of safety are taken into account in relation to the bed user's needs.
When prescribing a bed and mattress for a particular individual the clinical
evaluation includes: the bed user's needs, those who support them, the
environment the bed is used in, and the specifications/properties of the bed and
mattress.
A support surface is a surface on which the patient is placed to manage pressure
load, shear, friction and microclimate. This includes bed, trolley and operating table
mattresses; integrated bed systems; and seat cushions (Pan Pacific Clinical
Guideline 2012). This manual will only address beds, mattresses and extra
pressure care items for use on the bed support surface.
Recommended Assessments and Measures
1. OT assessments/Bed Assessments
Considering the persons physical needs, health, and understanding of the bed
user’s situation, is important when recommending beds and extra items added to a
bed frame.
Scope’s Bed Assessment Tool - relates to bed users with higher support
needs (www.scopevic.org.au )
3
Acknowledgments for information and use of images go to:
Independent Living Centre; Endeavour Industries; Yooralla AT Learning
SA Bed Rail Information
http://www.sa.gov.au/upload/entity/1646/DS%20documents/information-
sheets/bed-rails.pdf
2. Entrapment
Considerations of possible entrapment areas for the individual bed user
should be taken into account. Entrapment areas can occur due to mattress
style; if bed rails or bed sticks are used; as well as the position of the bed in
the room, with walls creating spaces. The use of bedding, wedges or sleep
systems included within the bed area require care in placement so that the
bed user does not become caught up in these items.
Check that the bed, mattress and any extras meet the Australian standards for
the items being recommended.
Ref: FDA Guidance, Hospital Bed System Dimensional and Assessment Guidance to Reduce Entrapment (March 10, 2006)
4
Acknowledgments for information and use of images go to:
Independent Living Centre; Endeavour Industries; Yooralla AT Learning
Information on entrapment areas for an adult can be found in:
Australian Standards AS/NZS 3200:2.38:2007
Scope’s Bed Assessment Tool (pages 8-10) - Appendix 1.
3. Restraint and seclusion
Understanding and undertaking a risk assessment in relation to possible
restraint and seclusion should be included when extra items are added to
the bed frame, including styles of mattress and position of bed within the
bedroom.
Restraint in bed is when the bed user wishes to leave the bed but is prevented in
doing so due to the extra item added to the basic bed.
Seclusion is when the bed user is isolated from others when normally they would
be interacting with them.
Extra items including bedrails, bed rail covers, concave mattress, sleep systems
require a risk assessment with consideration for restraint and seclusion.
The Office of the Senior Practitioners provides definitions of mechanical restraint
and seclusion.
http://www.dhs.vic.gov.au/for-individuals/your-rights/offices-protecting-rights/office-of
-the-senior-practitioner
Restraint and seclusion does not include devices for therapeutic purposes and thus
for therapeutic reasons extra items can be used for specific bed users that restrict or
subdue their movements.
4. Pressure care considerations
Pressure Injury (PI) risk assessment includes consideration of both the bed user
and the environmental factors that are associated with development of PI.
All added equipment that interfaces with the individual on the support surface must
be assessed for potential to increase pressure, shear, friction, moisture and
temperature.
Pressure injury development is influenced by the magnitude and duration of
unrelieved pressure, and the individual’s tissue tolerance to pressure.
The clinical question of how long and how much pressure an individual is exposed
to, and the skin’s response to pressure, shear, friction, and moisture is useful to
include in this assessment.
Immobility, inactivity and sensory deficit all impact on pressure duration.
5
Acknowledgments for information and use of images go to:
Independent Living Centre; Endeavour Industries; Yooralla AT Learning
The magnitude of pressure is impacted by body asymmetry, changes in body
position, and the degree of, and surface contact with, the user (potential for pres-
sure redistribution).
The impact of pressure is increased when shear, friction, moisture and tempera-
ture change are present.
5. Clinical Risk assessment and Pressure Injury Risk Assessment Scales
Use a pressure injury risk assessment scale in conjunction with a
comprehensive clinical risk assessment to determine the bed user’s risk of
pressure injury and to inform the development of a prevention plan and
selection of a support surface. (Pan Pacific Guideline 2012)
A risk assessment scale offers a structured approach to assessment, but does
not replace a comprehensive clinical risk assessment. (Pan Pacific Guideline
2012)
A comprehensive clinical risk assessment should include: clinical history,
pressure injury risk scale, skin assessment, mobility and activity assessment,
nutritional assessment, continence assessment, cognitive assessment, and
assessment of extrinsic risk factors (Pan Pacific Guideline 2012)
The Braden Scale, Norton Scale or Waterlow Score are validated and reliable
scales for assessing pressure injury risk in adults. (Pan Pacific Guideline 2012)
http://www.bradenscale.com/images/bradenscale.pdf
http://www.health.vic.gov.au/older/toolkit/09SkinIntegrity/docs/Waterlow%
20Scale.pdf
6. Trials: Testing the user on the mattress and the bed
Wherever possible, air mattresses and other multi- layered mattresses need to be
trialled in the home setting, for one week minimum, on the prescribed bed base.
Assess all bed transfers and bed mobility.
Test for “bottoming out” potential in all relevant bed profile positions, eg. sitting up
with head raised, lateral lying, supine, knee bend, leg raise.
Heel protection needs to be considered separately to mattress prescription.
7. Equipment: Product Review
ILC - Pressure Care Matrix - Appendix 2
Product Checklists - Pressure redistribution support surfaces (Young and Dean
2011) - Appendix 3
Can be used to gather relevant product specification information to compare products.
Suppliers may not readily have this information but will usually source this from the
manufacturer.
6
Acknowledgments for information and use of images go to:
Independent Living Centre; Endeavour Industries; Yooralla AT Learning
Specifications of foam mattress http://www.dunlopfoams.com.au/frequently-asked
-questions
8. Considerations for non-standard body size bed users, including children
The current Australian Standard for beds is relevant for an average adult body size
only. When looking into a bed and mattress for a child or a non-average sized adult
their actual size needs to be taken into account.
For children the use of Cot Standards could be referred to for a child’s
finger and limb sizes.
For adults consider possible entrapment with care.
9. Sleep behaviour of a bed user
It is important particularly for children, who in some cases require support and
learning to know when it is time to sleep.
Resources including but not exclusive to:
Sleepwise – A Resource Manual from SA
10. Relevant Characteristic Considerations
Relevant bed user characteristics
Bed Users most at risk of injury, entrapment or death from ‘bed extra items’ are
those users who have:
a history of falls
cognition issues
decreasing insight into their situation
inability to seek assistance if they require it
movements they are unable to control.
Bed users most at risk of restraint or seclusion are those with:
cognition deficits and decreased understanding of their situation
inability to communicate their needs or desires
behaviours of concern, with specific reference to sleep patterns.
Bed users most at risk of pressure injury are those who have:
existing pressure injury
history of Stage 3 or 4 pressure injury particularly over pelvic girdle and lower
limb/heels.
multiple pressure injury risk factors.
7
Acknowledgments for information and use of images go to:
Independent Living Centre; Endeavour Industries; Yooralla AT Learning
limited ability to move or change position independently and who do not have
carers assistance during the night or a turning regime implemented
asymmetrical body posture
peak pressures over bony prominences due to reduced surface contact,
resulting in poor distribution of body weight over the mattress surface.
non-fading redness of skin over body prominences with particular refer-
ence to shoulder hips, bottoms and feet.
extended periods of time in bed, eg. greater than eight hours of sleep time.
it is important to consider future functional decline and/or possible improvement
of the bed user’s level of disability.
Acute illness (eg: chest infection/UTI) can increase a person’s potential to
develop a pressure injury in a very short period of time (hours) - therefore
clinicians may need to upgrade mattress equipment at these times.
Level of mobility is increased after immobilisation due to a fracture.
Relevant support person characteristics
Carers need to be physically and cognitively able to assist the bed user as they
require, eg. roll side to side.
Carer fitness to assist with transfers of bed user.
Features of equipment need to meet the requirements of the support person, eg.
bed height appropriate for carer as well as lower bed height for bed user’s
transfer or safety needs.
Bed user’s requirements are the determining factor for the support person’s
requirements, expensive bed verses a cheaper one that can still meet bed user’s
needs?
Relevant characteristics in the environment
All equipment that interface with the bed user and the bed need to be compatible,
eg. including bed user’s wheelchair, hoist, environmental control etc.
Appropriate circulation space that allows for positioning of equipment for
functional use, eg. wheelchair access to the bed, floor hoist fits under bed, etc.
Consideration of possible future requirements of the bed user, eg. High-low bed
with head adjustment and knee bend for future support to sit up in bed.
Consider the impact of environment on microclimate at the skin’s surface.
Relevant equipment considerations
Product assessment: Match product specifications against identified clinical
needs of the user.
8
Acknowledgments for information and use of images go to:
Independent Living Centre; Endeavour Industries; Yooralla AT Learning
Equipment trials, in local home/local community – conduct these for one week,
where possible, with more complex conditions and backgrounds.
Cleaning: check manufacturers recommendations (supply client with this written
information).
Maintenance: Consider alternative product, if client and carer are unable to
manage the maintenance schedule.
Powered units: discuss emergency plan in case of power failure, eg. foam
mattress as alternative to user lying on deflated powered mattress
replacement.
Life of the product: specify this timeframe to user and recommend review prior to
this date.
9
Acknowledgments for information and use of images go to:
Independent Living Centre; Endeavour Industries; Yooralla AT LearningDescription of Equipment
A. BA1 - Beds
A basic bed is a supportive flat surface with two ends, which holds the surface that supports a person off the floor.
When additions to a basic bed are necessary, considerations of what and why items are adding is required, with clinical reasons and safety
considerations for the Bed User and those supporting them.
Items to consider:
Name Description Use Safety concerns
Bed types and features
BA1A - High/Low Height adjustable beds
Head adjustment Top section of bed is raised or lowered Assists bed user • Care needs to occur where the bed
to the horizontal mid-section of bed base • to sit up user has issues relating to
(eg. Range 0-60o) • to raise chest and head due pressure.
to respiratory concerns
• Mattress used needs to profile
(bend) to the hinge points on the
bed.
Knee Bend The lower section of the bed rises in a Assists bed user to support • Care needs to occur where the bed
scissor action allowing the knee to bend lower limbs. user has issues relating to
and have the calf supported, the foot is pressure.
angled down. Can assist to reduce pressure
on the heels. • Mattress used needs to profile
(bend) to the hinge points on the
bed.
Acknowledgments for information and use of images go to:
Independent Living Centre; Endeavour Industries; Yooralla AT Learning
10Name Description Use Safety concerns
Leg Raise The lower section of the bed rises in a Assists bed user to support • Care needs to occur where the bed
scissor action that flexes the hip and lower limbs. user has issues relating to
knee joints, supporting the calf. pressure.
• Mattress used needs to profile
(bend) to the hinge points on the
bed.
BA4A – Goes close to floor, minimum foot For use if bed user is likely to • Consideration of higher heights
Low to floor bed clearance required as per Australian fall from bed. required as high range may be
Standard. compromised as bed starts at a
lower point.
BA4A1 – Goes close to floor using height For use if bed user is likely to • Care needs to be taken that bed
Column bed adjustment at head and foot end of bed. fall from bed user is unlikely to move under bed.
Acknowledgments for information and use of images go to:
Independent Living Centre; Endeavour Industries; Yooralla AT Learning
11Name Description Use Safety concerns
BA4A2 - Trendelenberg This function provides flat positioning of Prescribed in situations • Care needs to be taken so that the
function the bed user so that their head is raised managing respiratory issues, bed user does not slide down/up in
and feet lowered (reverse swallowing issues and bed when used.
Trendelenberg) or vice versa pressure area care.
(Trendelenberg).
A board at ends of the bed is normally
required - known as a head and foot
board, to prevent the pillow and
mattress from slipping off the bed.
Bed sizes The most common sizes are: Choosing size of bed requires • Be aware of the environment in
• Single consideration of bed user’s which the bed is to be located, so
body size, position they sleep that circulation space and access
• Wide single – same length as single and their ability to move by the bed user and support people
just wider around the bed to transfer are taken into account.
• King Single – wider and longer than on/off. • Wider beds require support person
single to reach further to assist bed user.
• Narrow Single - can be added Wider beds can give a bed
together to make a double user space to roll in bed
without coming out of bed.
• Bariatric King Single – allows for bed
users of greater weight
• Length and width extensions are
available on some standard size
beds
• Customised sizes to suit bed users
requirements
Note: actual bed sizes vary between
manufacturers.
Acknowledgments for information and use of images go to:
Independent Living Centre; Endeavour Industries; Yooralla AT Learning
12Name Description Use Safety concerns
BA2A – Also known as over-head bar, monkey bar The bed user needs to have • When free standing the Self Help
Self Help Pole or goosenecks, these are items that hang the ability to reach up and Pole must be stable and positioned
over the bed user’s upper body/head whilst hold their own body weight so appropriately with consideration of
in bed. that they can re-position load capacity and intended use
themselves in bed. • Upper body strength and shoulder
These items can be free-standing or
girdle stability needs to be
attached to bed frame
assessed as shoulder pain and
damage is a high risk of use
• Entrapment needs to be assessed
when positioning the upright pole
BA2B – Used to raise bed height. To increase bed mattress • When raising the bed care is
Bed blocks height for bed user’s transfer required so that the bed does not
or so equipment can be used become unstable.
under bed, such as floor hoist.
Acknowledgments for information and use of images go to:
Independent Living Centre; Endeavour Industries; Yooralla AT Learning
13Name Description Use Safety concerns
BA5A – Used to assist with transfer/sitting up: Assist bed user to transfer • Straight bed sticks have been known
Bed stick/pole to/from bed. to impale a bed user so should not
• Fold down attached to bed frame
be recommended. Alternative bed
• Attached to side of bed frame Assist bed user to move sticks that are curved at the top are
• Slide in, either double or single style when in bed. available
• The position of the bed stick
in the bed under the mattress
is important as if not
positioned appropriately it can
cause entrapment and
possible hanging
• Slide in bed sticks rely on the weight
of the person and mattress. They
can move and require regular
reviews and re-positioning.
• Slide in bed sticks are not
recommended for profiling powered
beds.
• Slide in bed sticks are NOT
recommended because of
entrapment and hanging risks.
Acknowledgments for information and use of images go to:
Independent Living Centre; Endeavour Industries; Yooralla AT Learning
14Name Description Use Safety concerns
BA10A – Also known as cot sides and bed sides. Bed rails are placed on the • Any bed rail has to be
Bed rails sides of the bed to prevent the assessed in relation to restraint
Types of bed rails include: bed user from coming out of bed of the bed user, if it prevents
• Full length – full side of bed from head either intentional or them from exiting the bed.
board to foot board unintentionally. • Entrapment needs to be
• ¾ length- allowing small gap at each assessed when positioning bed
end Bed rails can be used by bed rails with care in relation to
user to reposition themselves space between rails, between
• ½ length-these can be used in different when in bed.
configurations with two per side mattress and rail, rail ends and
bed ends, between rails and
• Split rail – usually two half rails with a Bed rails can limit access by under rail and bed base.
space between and connected to bed others to bed user Australian Standard (AS/NZS
frame 3200.2.38 – 2007). Zone 1 to 7
• Slot in – requiring removal by non-bed provide space requirements
user and limitations in relation to
• Fold down – usually ¾ or split rail possible entrapment areas for
an average adult body size.
• Fold into bed frame style – usually split
or half rail style • Consideration of alternatives to
bed rails is encouraged due to
the severe consequences of
entrapment and asphyxiation
that have been reported in the
Coroners Court when bed rails
have been used.
• Slide in bed rails of any type
Slide in rails – care is require if used, are considered unsafe as they
however it is not recommended to use this can move and can entrap the
style of rail at anytime. bed user or come away from
the bed altogether and allow
the bed user fall out on top of
the rail.
Acknowledgments for information and use of images go to:
Independent Living Centre; Endeavour Industries; Yooralla AT Learning
15Name Description Use Safety concerns
Bed wedges or postural positioning devices Wedges to minimize Bed • Consideration of restraint
User rolling. Can also use of bed user is required with
concave style mattress to these options.
provide soft edge to bed (see
mattress section) and sleep
systems to minimise movement
of Bed User.
BA10B – Placed on bed rails as padding. Used to minimise injury to limbs • Great care is required with
Rail protectors (if the bed rail is knocked) and consideration of compression
entrapment. of any padding which could
allow entrapment rather than
prevent it.
• Breathable padding surface
should be considered.
BA10C – Positioning items added to or as part of the For support to bed user • Clear written instructions on
Sleep Systems for pressure care mattress of the bed to support the bed users correct use and length of use
body when lying in bed are required to maximise care
the system will provide.
• Any item that prevents the bed
user from exiting the bed can
be considered as a restraint, so
a clear understanding of the
systems use is very important.
Acknowledgments for information and use of images go to:
Independent Living Centre; Endeavour Industries; Yooralla AT Learning
16Additional non-funded items
The items below are NOT FUNDED through SWEP but are items that can be used in relation to beds and so have been added to this manual for
therapists to consider as possible options even when they are not funded through SWEP.
Name Description Use Safety concerns
Bed cradle Holds blankets off bed user’s feet and legs Provides pressure relief from • Consideration of entrapment
blankets to lower limbs needs to be assessed prior to
positioning items such as bed
cradles and IV poles although
these are usually placed where
a bed user does not access.
• If the item is a slide under
mattress style it can easily
move position, so careful
consideration is required as to
outcomes if it moves.
IV Pole Is an accessory to attach to the bed that is Used for PEG feed bottle or
higher than the bed user in the bed similar use.
Floor mats/Fall out mats Used beside bed to cushion a fall from bed Great care needs to be taken
and/or to decrease carpet scratching bed with OH&S perspective if Fall
users skin. Out mats are used as staff can
trip on edge.
• These can soften a roll out of
bed, but bed needs to be low to
floor to minimize any fall
distance
• Staff needs to be aware these
mats are being used as they
can be a trip hazard.
Acknowledgments for information and use of images go to:
Independent Living Centre; Endeavour Industries; Yooralla AT Learning
17Name Description Use Safety concerns
Bed mat alarms which react to pressure Great care needs to be taken
alerting to: with OH&S perspective if any
• Pressure being applied, ie. stood on – style of mats or item around
eg. floor mats bed that is not easily noticed
by support person when
• Pressure being removed, ie. person attending bed user.
getting up/out of bed – so when no
pressure alarm activates
• Needs to be a support person
who is able to attend quickly if
Light beams activated by movement
alarm is activated.
• Under bed so when a bed user exits bed
the light is ‘cut’ and alarm occurs
• End of bed or on wall behind bed, when
user sits up or exits the bed the beam is
broken triggering the alarm
• At door to note bed user is leaving the
room
These items have a place, however they
only alert after a person has come out of
bed and are only of value if there is
someone to respond
Acknowledgments for information and use of images go to:
Independent Living Centre; Endeavour Industries; Yooralla AT Learning
18B. Mattresses
It is very important that the Mattress fits the bed base correctly, therefore using the same supplier for bed base and mattress is usually the
most appropriate, but if a different mattress is required, make sure the bed base fits the mattress.
If the mattress is too big or small for the bed base then entrapment issues can arise, even if extra items on a bed are correctly assessed for
minimizing entrapment.
Name Description Safety concerns
BA3 A & B • Specifications density/firmness - see Pan Pacific • Restriction of a bed users movement within the
Basic Mattress Pressure Guidelines 2011, page 41) bed can increase pressure risk if bed mobility is
Redistribution (PR) Mattress, reduced by this mattress design
foam or inner spring or • Minimum depth of mattress to be 15cm.
combination • Consideration of firmness of edges if bed user sits on side • Compression of mattress edge will impact on
of the bed for transfers entrapment concerns
• Consideration of mattress bending for head and knee • Inner spring combination mattresses need to
bend options on bed frame meet the features and size of bed base correctly
as an inner spring does not move for head and
• Two-way stretch and moisture resistant/breathable knee bend adjustments.
covering
• Inner spring mattresses may not provide
• Inner spring mattress has more rebound and can be used sufficient immersion and pressure redistribution
to assist the bed user to mobilize on the mattress. for higher risk users. Foam multi-layered
combination mattresses should be considered for
these users.
Acknowledgments for information and use of images go to:
Independent Living Centre; Endeavour Industries; Yooralla AT Learning
19Name Description Safety concerns
BA6 • Concave Mattress that has higher edges providing a soft • Consider restraint potential with raised edges on
PR mattress replacement (non edge and directs bed user to remain in the middle of the a mattress.
Powered) mattress • Restriction of a bed user’s movement
• Pressure redistribution mattress replacement foam and within the bed can increase pressure risk if
adjustable air, gel or visco-elastic foam/low resilience bed mobility is reduced by this mattress
foam (memory foam) inserts. and/or insert design, however usually
• Minimum insert depth 7.5cm these mattresses provide pressure
redistribution due to the bed user’s
• Foam Minimum standard (Pan Pacific guideline 2011). pressure requirements.
• Consideration of mattress bending for head and knee • Compression of mattress edge will impact on
bend options on the bed frame if a bed has these features entrapment concerns
• Two way stretch and moisture resistant/breathable
covering
Acknowledgments for information and use of images go to:
Independent Living Centre; Endeavour Industries; Yooralla AT Learning
20Name Description Safety concerns
BA7 • Min cell depth 10cm • Any edge to a mattress has to be considered in
PR mattress overlay to be relation to restraint of the bed user, if it prevents
positioned over a PR Mattress, • Ensure under mattress is the same size as overlay or that
adjustments are provided them from exiting the bed.
either non-powered or active
(powered) • Restriction of a bed user’s movement
within the bed can increase pressure risk if
bed mobility is reduced by this mattress
and or insert design.
• Compression of mattress edge will impact on
entrapment concerns but this is particularly
relevant for active overlays as entrapment can
occur during the cycle and so a full assessment
is required.
BA8 - Other Pressure Ulcer • Foot/heel pressure relieving devices including products of • When a bed user uses an item in bed with them, a
prevention items fibre, foam, gel and air risk assessment if the item comes loose or is
• Foot and Body wedges caught up needs to occur. Use of clear written
instructions and regular review of the items use
would assist in determining benefits of using the
devices.
• Any item, including wedges, being used to restrain
the bed user, if it prevents them from exiting the
bed, needs consideration in relation to restraint
versus postural support needs.
Acknowledgments for information and use of images go to:
Independent Living Centre; Endeavour Industries; Yooralla AT Learning
21Name Description Safety concerns
BA11 - Full PR mattress • Active (powered) systems that fits the bed size • Compression of mattress and the cycle of variable
replacement air cells will impact on entrapment concerns but
• Alternating air large single cell or dual layers
this is particularly relevant for active overlays as
• Combination of active upper layers and foam or static air entrapment can occur during the cycle: a full
lower layer assessment is required.
• Single zone or multi zoned cells
• Low air loss
• Alternating air mattress replacement – 8”or 20cm min
depth
Acknowledgments for information and use of images go to:
Independent Living Centre; Endeavour Industries; Yooralla AT Learning
22References, Further Readings and Resource Links
Bibliography of current articles and Standards
1. Australian & New Zealand Standard:3200:2.38:2007
2. AS/NZS 2130:1998 – cot standards
3. AS/NZS 4220:1994 - Bunk Beds
4. ‘Bed safety off the rails’ by T Nowicki, P Fulbrook & C Burns – Australian Nursing
Journal – July 2010 Vol 18 pages 31-34. Provides some entrapment space
information and restraint.
5. A Guide for Modifying Bed Systems and Using Accessories to Reduce the Risk
of Entrapment Hospital Bed Safety Workgroup (HBSW) in partnership with FDA,
June 21st 2006
6. ‘Bedrails, risk and safety’ from Nursing & Residential Care, October 2008 Vol 10,
No10 – Good description on Restraint but UK Journal.
7. ‘Reducing the risk of accidental hangings, entrapment’ by B.MacLaughlin
Frandsen, April 2010
http://www.ltlmagazine.com/article/reducing-risk-accidental-hangings- entrap-
ment
8. ‘Clinical Guidance For the Assessment and Implementation of Bed Rails In
Hospitals, Long Term Care Facilities, and Home Care Settings’ North American
Study Clinical Guidance For the Assessment and Implementation of Bed Rails In
Hospitals, Long Term Care Facilities, and Home Care Settings Hospital Bed
Safety Workgroup in partnership with FDA
http://www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/
GeneralHospitalDevicesandSupplies/HospitalBeds/ucm123676.htm
9. Hospital Bed System Dimensional and Assessment Guidance to Reduce
Entrapment Guide to Bed Safety Hospital Bed Safety Workgroup (HBSW) in
partnership with FDA Brochure
www.fda.gov/MedicalDevices/DeviceRegulationandGuidance/ GuidanceDocu-
ments/ucm072662.htm
23
Acknowledgments for information and use of images go to:
Independent Living Centre; Endeavour Industries; Yooralla AT Learning10. ‘Preventing Bed Entrapments: A Report from the Hospital Bed Safety Working
group’ – by E Bills – Biomedical Instrumentation & Technology page 227 – 229.
Details entrapment zones in detail.
11. HBSW/FDA Frequently Asked Questions (FAQ) on Entrapment Issues
Hospital Bed Safety Workgroup (HBSW) in partnership with FDA, October
9th, 2007
http://www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/
GeneralHospitalDevicesandSupplies/HospitalBeds/ucm123467.htm
12. Hospital Bed Safety Evaluation in Hospital & Nursing Homes.Investigators: G.
Powell-Cope, Nelson, S. Hoffman, M. Tate, L.
13. SA BedRail
http://www.sa.gov.au/upload/entity/1646/DS%20documents/information-
sheets/bed-rails.pdf
14. Scope Vic – Equipment www.scopevic.org.au
15. NSW Department of Health – Bed Users
16. Australian Bariatric Innovations Group (AusBIG) Director: Janet Hope
www.ausbig.com.au
Pressure Care Assessment and Equipment Prescription
1. International Review. Pressure ulcer prevention: pressure, shear, friction, and
microclimate in context. A consensus document London: Wounds International
2010. http://www.woundsinternational.com/pdf/content_8925.pdf
2. Pan Pacific Pressure Clinical Practice Guideline for prevention and
management of pressure injury: 2012.
http://www.awma.com.au/publications/
2012_AWMA_Pan_Pacific_Abridged_Guideline.pdf
3. National Pressure Ulcer Advisory Panel. (2007). Support Surface Initiative
www.npuap.org/NPUAP_S3I_TD.pdf
4. National Pressure Ulcer Advisory Panel and European Pressure Ulcer Advisory
Panel. Prevention and treatment of pressure ulcers: clinical practice guideline.
Washington DC: National Pressure Ulcer Advisory Panel: 2009.
24
Acknowledgments for information and use of images go to:
Independent Living Centre; Endeavour Industries; Yooralla AT Learning5. European Pressure Ulcer Advisory Panel. Pressure ulcer prevention guidelines.
http://www.epuap.org/guidelines/Final_Quick_Prevention.pdf
6. Norton, L., Coutts, P., Sibbald, G. (2011). Beds: Practical management
for Surfaces/mattresses. Advances in Skin and Wound Care. Vol 24(7)
324- 332
7. Braden Scale: pressure ulcer risk assessment tool for Adults –
http://www.bradenscale.com/images/bradenscale.pdf
8. Braden Q pressure ulcer risk assessment tool for children:
http://www.health.qld.gov.au/psq/pip/docs/braden.pdf
9. Waterlow Pressure Ulcer risk Assessment tool
http://www.health.vic.gov.au/older/toolkit/09SkinIntegrity/docs/Waterlow%
20Scale.pdf
10. Pressure ulcer prevention and management guideline.
Specialty fact sheet for practical considerations for clients in the community.
Developed by the Pressure Ulcer Prevention Collaborative, Queensland Health.
May 2012
http://www.health.qld.gov.au/psq/pip/resources.asp
11. Wounds West Education Program
http://www.health.wa.gov.au/woundswest/education/index.cfm
12. Department of Human Services – Consumer Information
http://www.health.vic.gov.au/pressureulcers/
Department of Human Services – Online Educational Course for Clinical Staff
http://www.health.vic.gov.au/pressureulcers/education.
Module 1 – Understanding Pressure Ulcers
(Duration: approx. 45 mins)
Outlines the occurrence of PUs and describes the impact they have on patients, carers and
the health care system.
Module 2 – Risk Assessment
(Duration: approx. 25 mins)
Describes the importance of assessing PU risks and outlines the use of risk assessment tools.
Module 3 – Developing a Prevention Management Plan
(Duration: approx. 25 mins)
25
Acknowledgments for information and use of images go to:
Independent Living Centre; Endeavour Industries; Yooralla AT LearningOccupational Therapy Assessment for Bed Systems Safety
To be completed by OT in conjunction with Bed User and the people who support them.
General Information:
Bed User: _________________________ Age: ________Assessor: _________________________
Address of Bed User: __________________________ Date Assessed: ___________________
______________________________________________________________
Significant Others: ________________________________________________________________
Relationship to Bed user: __________________________________________________________
Primary Disability: _________________________________________________________________
Other Conditions: _________________________________________________________________
Health Issues:
History of Seizure activity ? No / Yes If Yes note
• Frequency __________________ and Type ______________________________
• Implications ____________________________________________________
Has the Bed User recently had a health issue? No / Yes
• If Yes please note ____________________________________________________
Does Bed User have oedema in lower limbs ? No / Yes
• If Yes please note reason ____________________________________________
Is the Bed User under weight or obese?
No / Yes
• If Yes please detail ________________________________________________
Does Bed User have any Pressure issues/Pressure Ulcers ? No / Yes
• If Yes please note where ____________________________________________
Does the Bed User have sensation issues? No / Yes
• If Yes please describe ________________________________________________
Does the Bed User have limited insight? No / Yes
• If Yes in what areas related to bed use ________________________________
_________________________________________________________________________
Is the Bed User able to call/ seek assistance if required No / Yes
• If No please comment _______________________________________________
• If Yes describe ____________________________________________________
Is there someone who can provide assistance during the night No /Yes
• If No please comment _______________________________________________
• If Yes who __________________________________________________________
August 2011
Page 1 of 12
26Occupational Therapy Assessment for Bed Systems Safety
To be completed by OT in conjunction with Bed User and the people who support them.
Health Issues (continued):
Does the Bed User have habits that are unsafe or behaviours of concern?
No / Yes
(example does the person smoke in bed or have a behaviour support plan in relation to night time activities)
• If Yes please describe ________________________________________________
_________________________________________________________________________
Does Bed User have Asthma, history of aspiration, pneumonia, ventilator support or
other respiratory issues No / Yes
• If Yes please describe _______________________________________________
Does the Bed User have involuntary movements? No / Yes
• If Yes please describe ________________________________________________
Is the bed user able to move in the bed independently No / Yes
(roll from prone to supine, move up down bed and or to edge of bed)
• If No describe ____________________________________________________
• If Yes describe ____________________________________________________
Information on Bed Use:
What is the bed used for: Comments Recommendations
for the situation **
Sleeping, note times (eg 8pm to 6am)
Stretch out/ relax space, note times
Changing, does the User assist
Dressing, does the User assist
Other comments
** On last page of Assessment please re write what equipment if any is required for each use of the bed
Bed Use Routine:
Bed routine is important and should be considered as should factors that relate to sleep
time.
What are the rituals that allow the bed user to relax and sleep, eg read a book or listen
to music, but also, what things do they do as routine to get ready for bed & sleep.
August 2011
Page 2 of 12
27Occupational Therapy Assessment for Bed Systems Safety
To be completed by OT in conjunction with Bed User and the people who support them.
Bed Use Routine (continued):
Note important facts in relation to sleep time and use of bed
Bed Users History of Bed Use:
Has Bed User had piror incidents of falls from bed No / Yes
• If Yes describe ____________________________________________________
Has Bed User been caught in Bed Rail, Bed stick &/or Bedding No / Yes
• If Yes describe ____________________________________________________
Has Bed User had pillows or items within the bed fall over their face No / Yes
• If Yes describe ____________________________________________________
Has Bed User had any injuries from their bed / related to their bed No / Yes
• If Yes describe ____________________________________________________
Other comments that can have influence on Bed Users situation.
Eg: Used to sleep in same bed as partner/parent until moved to CRU 6 months ago.
Information on Equipment:
This section allows for comment on current equipment used together with comments as
to the proposed equipment that would be suggested and why.
1. Bed
a) Brand and model:
• Consider risk factors of proper installation has according to manufacturer’s
instructions
• All parts of equipment are compatible
• If pieces that have been added or replaced do not alter overall integrity of
Bed
August 2011
Page 3 of 12
28Occupational Therapy Assessment for Bed Systems Safety
To be completed by OT in conjunction with Bed User and the people who support them.
Information on Equipment continued ….Bed:
Current Bed Proposed Bed
Comments Reason
b) Size of Bed: Add measurements to assist with decisions.
• Consider Single, Wider Single (wider only), Longer Single (just longer),King Single (wider &
longer) or customised size
Current Bed Proposed Bed
Comments Reason
c) Features of Bed:
• Consider, height adjustment (manual or electric), head elevation and knee bend/break as
well as caster locking.
Current Height Proposed Height
adjustment adjustment
Bed Head Bed Head
elevation elevation
Knee Knee
bend/break bend/break
Wheels/cast Wheels/cast
ers ers
Comments Height Reason Height
adjustment adjustment
Head Head
elevation elevation
Knee Knee
bend/break bend/break
Wheels/cast Wheels/cast
ers ers
2. Mattress (note mattress needs to fit the bed frame and not move as bed user transfers to from bed)
a) Type:
• Flat, concave pressure redistribution foam, inner spring, mattress overlay and
mattress replacement, mattress inserts, etc ………………………………………..
• Include dimensions (length, width & depth) if required for ordering purposes
Current Proposed
Mattress Mattress
Comments Reason
Information on Equipment continued……mattress
August 2011
Page 4 of 12
29Occupational Therapy Assessment for Bed Systems Safety
To be completed by OT in conjunction with Bed User and the people who support them.
b) Pressure redistribution features:
• Comment on what is required for appropriate pressure care for bed user.
• What assessments have been used to determine risk _________________________
Comments__________________________________________________________________________
3. Extra’s used when bed is in use
a) Rails – ½ rails, ¾ rail, full length rail.
• Risk factors to consider in relation to bed rails would include are they
mechanically sound, firmly attached to the bed and are all latches in
working order.
• Entrapment possibilities are very important to consider please use pages 10
to 11 to evaluate entrapment risk.
Current Bed Rails Proposed Bed
if used Rail use
Comments Reason
In what bed use
situation
b) Rail covers used or not and if so what type
• Risk factors to consider in relation to covers would include are they
breathable, washable and padded covers need to be soft enough to
prevent trauma, but rigid enough to prevent entrapment. (eg like a mess
slung seat on wheelchair)
• Entrapment possibilities are very important to consider
Current Covers Proposed Covers
for Bed Rails for Bed Rail use
if used
Comments Reason
In what bed use
situation
August 2011
Page 5 of 12
30Occupational Therapy Assessment for Bed Systems Safety
To be completed by OT in conjunction with Bed User and the people who support them.
Extra’s used when bed is in use (continued)
c) Bed Pole/Bed Stick
• Risk factors to consider in relation to bed stick/pole would include position
so the Bed User can reach and use as well as not affect transfers
• Entrapment possibilities are very important to consider unless the bed
pole/stick can be removed/dropped
Current bed stick Proposed bed
used stick use
Comments Reason
In what bed use
situation
d) Monkey bar
• Risk factors to consider in relation to monkey bar would include position so
the Bed User can reach without harm to shoulder/arm of Bed User
Current bed Proposed bed
extra item used extra item use
Comments Reason
In what bed use
situation
e) IV pole
• Risk factors to consider in relation to IV pole would include position so it can
deliver the fluid required at the required rate
Current bed Proposed bed
extra item used extra item use
Comments Reason
In what bed use
situation
f) Fall out mats beside bed
• Factors to consider in relation to fall out mats would include
does the bed lower to a reasonable height to make fall out mats a
safer option from the Bed Users point of view
are the edges visible at night, not a trip hazard , are there other
safety considerations for carers.
Current fall out Proposed use of
mat used Fall out mat.
Comments Reason
In what bed use
situation
August 2011
Page 6 of 12
31Occupational Therapy Assessment for Bed Systems Safety
To be completed by OT in conjunction with Bed User and the people who support them.
Extra’s used when bed is in use (continued)
g) Pillows:
•Factors to consider in relation to pillows would include
what numbers are used verses required.
have there been any incidents of pillows falling over the bed user’s?
Current number Proposed
of pillows used change to use.
Comments Reason
In what bed use
situation
h) Wedges/postural items/splints/sleep systems
• Factors to consider in relation to these items would be the reason are they used, has fire
safety been considered and are they able to stay in position during when in use
Current what is Proposed
used change to items
used
Comments Reason
4. Overall look of bed to be ‘home like’ Yes / No
Comments: ____________________________________________________________________
Definition of ‘home like’ Domestic design, which does not resemble a hospital style bed (i.e. hospital style beds often consist of a metal
frame, metal/plain head and foot boards).
5. Location of Bed in Bedroom:
• Consider position for access on either side and location near wall with
possible entrapment issues
**Use Bed Rail Evaluation on Pages 10 to 11 of this Assessment as wall can act as an entrapment zone **
Sketch room and position of furniture when bed is in use.
6. Carers needs:
Comment on specific requirements of the Bed User’s carers, being aware of height
range of bed required to achieve and consideration of equipment use.
August 2011
Page 7 of 12
32Occupational Therapy Assessment for Bed Systems Safety
To be completed by OT in conjunction with Bed User and the people who support them.
Guide to Evaluating Bed Rail Safety
These pages are to be used when Bed Rails, Bed sticks are indicated or the bed is pushed
against a wall.
WHERE DO THESE GUIDELINES COME FROM?
At the end of 2007 AS/NZS 3200.2.38:2007 - Medical Electrical Equipment Part 2.38:
Particular requirements for safety – Electrically and manually operated medical beds
for Adult use, were released. The Bed Rail zones in these Standards have been taken
from the IEC 60601-2-38 Ed.1.0 (1996) MOD.
The following Guide has been developed over time with Scope therapists’ input and
from Scope’s work with Yooralla.
WHAT DO YOU NEED?
You will need a tape measure to measure the critical areas of each entrapment
zone (refer to pages 10 & 11)
In some areas, it will also be necessary to have the bed user or another person (of
similar size to the bed user) available who can lie on the bed whilst measurements
are being taken
These measurements are guidelines only for preventing an adult person’s head neck
or body becoming accidentally entrapped. A smaller gap may be necessary to
prevent entrapment if the bed user is smaller than average. Check compatibility
between bed user’s size and weight with the bed and bed rails’ capacity or
dimensions.
WHAT IS INVOLVED IN THE PROCESS?
A. Measure the Bed Users head circumference, neck and chest as a guide
Standards consider Head Depth Neck Depth Chest Depth
(face to back of head) Greater than 60mm (anterior to posterior of chest)
sizes to be approx
Greater than 120mm Greater than 235mm
B. Is other equipment used with this person compatible eg hoist goes under bed.
Yes / No
If No, comment ______________________________________________________________
C. After identifying the initial risk factors in preceding pages of Assessment, proceed to
measuring the entrapment zones, using the evaluation process and the pictures as a
guide.
August 2011
Page 8 of 12
33Occupational Therapy Assessment for Bed Systems Safety
To be completed by OT in conjunction with Bed User and the people who support them.
Guide to Evaluating Bed Rail Safety (continued)
ENTRAPMENT EVALUATION PROCEDURES MEETS YES OR NO
ZONE AUSTRALIAN COMMENTS
STANDARDS
FIGURE 114
(1) Rail to • Place bed in flat position, elevate side rails. Distance is 60MM OR
mattress, (Elevate head end rails only for split rails.) less than
horizontal
• Push mattress against opposite side rails. 60 mm LESS
measurement
• With tape measure, measure the horizontal
distance between the side of the mattress Recommend:
and the inside surface of the side rail.
• Repeat with head elevation and knee bend
of bed elevated
(2) Board to • Place bed in flat position. Distance is 60MM OR
mattress, less than
• Ensure bed ends are properly installed.
horizontal
60 mm LESS
measurement • Push mattress to opposite end for each
measurement
• With tape measure, measure the horizontal Recommend:
distance between the end of the mattress
and the inside surface of the bed end at
head and foot end.
Note this measurement is important even if no
rail is being used
(3) Within rail and • Place bed in flat position, elevate side rails Distance is not
to top of rail SPACE
• Measure horizontal or vertical distance greater than
120 mm BETWEEN
between the 2 closest rails
RAIL
120MM OR
LESS
Recommend:
Rails can be either vertical or horizontal
(4) Top of rail to be • Height of top edge of side rail above the Mattress to top
uncompressed 220MM OR
mattress without compression. of side rail top
mattress
to be equal to GREATER
Important if Mattress Overlay is being used or greater than Recommend:
220mm
August 2011
Page 9 of 12
34Occupational Therapy Assessment for Bed Systems Safety
To be completed by OT in conjunction with Bed User and the people who support them.
Guide to Evaluating Bed Rail Safety (continued)
ENTRAPMENT EVALUATION PROCEDURES MEETS YES OR NO
ZONE AUSTRALIAN COMMENTS
STANDARDS
FIGURE 114
(5) Rail to bed end • Place bed in flat position, elevate side rails. Distance is
(board), both LESS THAN
• Measure that the distance between the rail less than or
ends at foot
equal 60MM OR
and head of and end board
to 60 mm GREATER
bed. • Measure both ends of bed
or equal to or THAN
greater than 235MM
235 mm Recommend:
(6) Between split • Place bed in flat position, elevate side rails. Distance is
rails LESS THAN
• Measure that the distance between the less than or
split rails is less than or equal to 60 mm or equal to 60MM OR
greater than 235 mm 60 mm GREATER
or THAN
equal to or 235MM
greater than Recommend:
235 mm
(7) For Split rails: • Place bed in flat position, elevate side rails, Distance is 60MM OR
Top of push mattress towards opposite side. less than
compressed
• Have a person (equivalent to client’s size) 60 mm LESS
Mattress to
bottom of rail, lie on his/her side on top edge of mattress.
at ends of rail** Have person’s shoulder positioned at end Recommend
of rail.
• With tape measure, measure the diagonal
distance from the top of the compressed
mattress to bottom of rail at the end of the
rail.
• Repeat with head elevated.
(8) For full length • Place bed in flat position, elevate side rails, Distance is 120MM OR
rails: Top of less than
push mattress towards opposite side.
compressed
• Have a person (equivalent to client’s size) 120 mm LESS
Mattress to
bottom of rail, on top edge of mattress. Have person’s ♦ Flat:
between rail shoulder positioned between rail supports. ___________mm
supports • With tape measure, measure the diagonal
♦ Head elevation:
distance from the top of the compressed
mattress to bottom of rail between rail ___________mm
supports.
• Repeat with head elevated. Recommend
August 2011
Page 10 of 12
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