Bed Rails for Bariatric Equipment
On 30th August 2023, the MHRA issued a safety alert NatPSA/2023/010/MHRA. Medical beds, trolleys, bed rails, bed grab handles and lateral turning devices: risk of death from entrapment or falls.
This has been a hot topic within trusts across the UK. Many questions have been posted in our community forum. But what does it mean for our plus-sized patients? The only reference to Bariatric equipment in the guidelines is;
Bariatric Beds: Bariatric beds allow the mattress base to be widened, however, when the bed is widened, the correct mattress for the bed size must be used. Using the incorrect mattress size could increase the risk of entrapment.
The other section that should also be considered is;
Active mattresses, hybrid mattresses and mattress overlays: Active, dynamic or hybrid mattresses or mattress overlays may be prescribed in order to reduce the risk of pressure injury. As these will raise the resting level of the user relative to the top of the bed rail, the effective height of the rail will be reduced. In turn this may increase the risk of the bed user falling from bed. Highly compressible surfaces may also create additional entrapment hazards.
The bed, mattress and rail system should be assessed in all configurations as these risks may not be obvious in a single arrangement. The risk assessment should consider the ‘worst case’ condition in particular: for example, the effective height of the top of the bed rail with the bed plus a fully inflated active mattress, or the highest point reached when an alternating cell mattress is used.
Do most plus-size patients arrive in hospital requiring a dynamic surface?
In my experience, and area of work, it is the most common surface used. However different trusts may see different trends.
When choosing the correct equipment, you need to weigh the pros and cons as no product is perfect for every patient; whether you are a plus-size patient or a general care patient. So, ask yourself, “Do I really need a larger bed or mattress for my patient?” Here are some things to ask yourself before putting your patient on larger equipment.
- Does my patient exceed the safe working load of your standard-sized beds and mattresses?
- When my patient is lying flat and siting up is all their body supported safely within the bed frame without touching the sides?
- Can you safely roll your patient without the risk of them falling?
But the most important question to ask your patient is, “What are you able to do on your own”.
Many nursing staff are wary when they see plus-size patients; they panic about the number of people they may need to care for them and order larger equipment with dynamic mattresses when it isn’t necessarily needed. This could hinder the patient’s movement, affect their mobility, and potentially increase entrapment risk. If they are mobile, this could potentially turn a mobile person into a bed-bound person.
Considerations if you do need bariatric equipment.
The most common types of support surface are dynamic/active, lateral turn, and hybrid mattresses. These come in various heights and widths, most commonly from 105cm to 120cm wide, but can be wider and up to 25cm in height. When choosing the right surface, you also need to ensure that the bed is compatible with that surface.
- Is the bed fixed width or width adjustable and does the mattress adapt correctly to fit the bed?
- If width-adjustable, is it possible to extend the bed wider than the mattress, potentially creating entrapment issues?
- How much does the mattress height affect the safe height of the side rails and is it safe for your patient?
- Do the positive outcomes for the patient outweigh the potential risks?
There are many different equipment suppliers out there so the equipment does vary, but the basics are all the same. Check with your supplier if you are not sure, as they will come out to help you train staff on the safe use of their equipment.
If in doubt give your supplier a shout!
Lee Sherwood, Chair of Sussex Back Exchange, shares some of his thoughts and considerations.
Bariatric beds come, broadly, in 2 types. Non-width adjustable and width adjustable. The former is used more in community settings and the latter is used more widely in hospital settings.
Width adjustable beds are an essential part of the care provision for plus-sized patients in allowing clinicians the flexibility to choose the best width of platform for the care that they are providing, and allowing the bed access to all areas of hospitals as they are moved. With these beds, it is important to understand what, if any, precautions need to be taken as the bed is widened and narrowed depending on usage. Is the bed narrowing only intended for transport and therefore supervision is required, or can the bed size be changed for therapeutic and long-term treatment?
It is also important for width expanding and narrowing mattresses to have sides that can be attached or attached deflating sides so that when mobilising, a patient is less likely to slip the side piece out when standing, or less likely to be an entrapment risk between unsecured sides and the internal structure of the bed.
Along with experience, support, and training given to porters with these beds is invaluable as they tend to be the staff that are changing the size of the beds on a regular basis. Pre and post-move checklists are a great way of ensuring that each time the bed is moved it is always returned to the correct state.
Bariatric beds in the community will encounter the same issues as standard beds when it comes to grab handles and grab handle placement. However, access to a wider range of equipment can make it harder to identify which mattress conforms to which bed. Bariatric bed sizes can range from 1050mm wide to 1400mm wide which can make it harder for prescribers to ascertain which support surface is best suited. Further complications can arise when the bed frame and support surface are issued by two separate clinicians.
To help with this, it has been suggested that a suitable support surface size (length, width, and height) be attached to each product page on prescriber’s web portals, and should be considered as essential as the overall dimensions, and cases where a support surface may be suitable with a bed rail height extender should also be included.
It is also of note that Bariatric support surfaces tend to be deeper than narrower solutions. This is to accommodate both higher SWL and atypical anatomy. The same is true of lateral-turning mattresses. Manufacturers of beds typically can accommodate support surface heights of 20cm. Lateral turning mattresses tend to be higher still at 25cm. When the mattress height exceeds the manufacturer's guidelines, clinical judgment is needed to assess the risk.
However, for a patient that may be unable to turn themselves, it is unlikely that the risk of entrapment is high. Attention should also be paid to the risk of the patient coming over the top of the side rail, and where needed, the degree of turn to each side should be monitored as well as the degree of the back rest.
Risks can also be created by a mattress being too small or not high enough, this relates to entrapment issues being possibly created where the top of a support surface does not meet the bottom of the bed rail.
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Further information on the new MHRA guidance on bed rails and bed levers will be provided to members in the next in the NBE webinar series on 26th March.
To register, check your inbox.