BEDS – Which bed-related
intervention do I select tonight?
Robin Townsend AUA (Physio), Grad Dip (Gerontology)
Falls at the Bedside
‘Research has indicated that between 10% and
50% of falls in residential aged care facilities
involve an environmental hazard, and over
half of them occur around the resident’s
bedside.’
National Ageing Research Institute (Oct 2009), p.17
2
Australian Commission on Safety and
Quality in Healthcare, ‘Preventing Falls
and Harm From Falls in Older People:
Best Practice Guidelines for Australian
Hospitals, Residential Aged Care
Facilities and Community Care 2009’
http://www.safetyandquality.gov.au/internet/safety/
publishing.nsf/Content/FallsGuidelines
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‘Successful residential aged care facility falls
prevention programs use a combination of’:
– ‘routine interventions ….. for all residents’
– ‘targeted and individualised falls prevention care
plans based on screening or assessment’
Falls Facts for allied health professionals (p.1)
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Guidelines and Recommendations
• ‘Fall and injury prevention needs to be addressed at the point
of care and from a multidisciplinary perspective.’ (p.1)
• ‘Use supervised and individualised balance and gait exercise
…’ (p.19)
• The resident’s ability to perform ADL’s in their environment
should be assessed (p.53)
• ‘Ensuring chairs and beds are at the correct height (ie when
the resident’s feet are flat on the ground, their hips are
slightly higher than their knees) (p.56)
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Choices ???
• Bed
– Hi-lo (≈25-30cm)
– Lo-lo
• Bed height
– Transfer height
– Low / lowest setting
– Floor level
• Mattress
– Flat
– Concave
– Pressure care
• Air
• Memory foam
• Overlay
– Fibrefill
– Foam
– Memory foam
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Further Choices
• Bed Siderails
– Up/down
• Bedpole
– Under-the –mattress
– Bolt-on
– Floor-to-ceiling
• Alarm
– Bed
– Floor
– Side-beam
• Mats
–
–
–
–
Foam - thick
Foam – thin
Carpet / Absorbent
Non-slip
• Slide sheets
• Bedding
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BED HEIGHT
• ‘Adjustment of bed height is a nursing intervention that
can improve STS performance and potentially reduce fall
risk.’ (p.60)
• ‘A bed placed in its lowest position …. may actually
contribute to unsafe transfer and falls.’ (p.61)
• ‘Those without the ability to transfer or walk may
benefit the most from very low height beds…. (Capezuti,
Talerico, et al, 1999)’. (p.62)
(Capezuti et al (2008), ‘Bed and Toilet Height as Potential
Environmental Risk Factors’)
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• ‘STS transfer ability is greatly
hampered at seat heights that are at
or less than 80% of lower leg length …’
• ‘Heights greater than 120% … also
deter successful STS transfer and
create a higher risk for falls …’
• ‘Seat height between 100% and 120%
of lower leg length is considered
optimal …’
Stick-to-Stand Tool
Blue tag = transfer height
Orange = lowest setting
(Capezuti et al (2008), ‘Bed and Toilet Height as Potential
Environmental Risk Factors’, p.51-2)
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X Bed/Chair Height & Hook-arm lift
Weight behind knees - difficult for quads muscles to work
effectively
Muscle weakness & poor function
Need for assistance
Increased falls risk
NB Foot position/knee angle
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√ Bed/Chair Height
Weight propelled forwards over knees – quads
muscles can do the push up into standing
Maintain muscle strength & functional skill
Safer transfers
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X Weight behind knees
√ Weight propelled forwards
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Mattress
Concave
May compromise sit-to-stand &
↑falls risk
More suitable for ‘rollers’
Pressure care / Overlay
Soft > increased difficulty bed
mobility & sit-to-stand
? Reduce falls risk
?? Restraint
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Bed Siderails
•Increase height of fall
oNB Lowest setting if using bedrails
• ‘Need to escape’ > climbing
over or around ends
• May increase safety for some
•NB Risk Assessment
o ‘What is this person most likely to do
tonight?
o How can I make this as safe as possible?
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Bedpoles
•Coroner’s Review & Recommendations(2010)
•Risk assessment
•Type
•Foam / light mattress = bolt-on bedpole
•Innerspring / heavy = under-the-mattress
bedpole
•Position
•Functional (PT/OT assessment)
•No gap between pole & mattress
•Bed head should not be elevated when asleep
(> entrapment risk between pole & metal frame)
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Bed Poles - ‘Coroner’s Review’
• ‘The South Australian Coroner has ruled that in certain
circumstances sufficient risk exists to question the use of ‘Bed Poles’
in certain circumstances.’
– history of falls from bed
– impaired physical
– impaired cognitive function
• Recommendations
– ‘…. reduce the extent of risk to residents’
– ‘…. physiotherapy and occupational therapy staff be involved in the
assessment process ….’
NB Refer to full report if prescribing bed poles
http://www.courts.sa.gov.au/courts/coroner/findings/findings_2010/Hutton_Arthur_John.pdf
http://acma.net.au/2010/06/coroners-review-of-use-of-bed-poles-subsequent-to-resident-death/
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MATS
Thick/Thin Foam
•Reduce injury risk
•Compromise balance
& safety
•Trip & slip hazard
carpet
NB - BRAKES ON BED
•Reduce injury risk
•Safer when wet
•Increase foot grip
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BED GUIDE
WHAT is THIS person MOST LIKELY to do?
NB: A guide only
HOW can I make this AS SAFE as POSSIBLE?
1
Able to STAND
Able to WALK
GOOD mobility
LOW fall risk
•TRANSFER height
•WALKING AID
by bed
•FLAT mattress
•? BEDPOLE
UNSTEADY
HIGH fall risk
•TRANSFER height
•WALKING AID
by bed
•FLAT mattress
•? BEDPOLE
•? ALARM
2
Able to STAND
NOT able to WALK
3
NOT able to STAND
NOT able to WALK
May try to walk
Very HIGH fall risk
May CLIMB,
CRAWL or ROLL
•LOWEST height
•MATTRESS
- FLAT easier s-t-s
- CONCAVE may
reduce risks
-? BEDPOLE
•? ALARM
•?? Bed side-rails
(caution)
•LOWEST height
•CONCAVE mattress
may reduce risks
•MAT by bed
•? ALARM
•?? Bed side-rails
(caution)
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REFERENCES
•
Aged Care Management Australia (2010) , Coroner’s review of use of ‘Bed Poles’ subsequent to resident deaths
http://acma.net.au/2010/06/coroners-review-of-use-of-bed-poles-subsequent-to-resident-death/ [Online 23/3/11]
•
Australian Commission on Safety and Quality in Healthcare, ‘Preventing Falls and Harm From Falls in Older People:
Best Practice Guidelines for Australian Hospitals, Residential Aged Care Facilities and Community Care 2009’
http://www.safetyandquality.gov.au/internet/safety/publishing.nsf/Content/FallsGuidelines
•
Capezuti et al (2008), ‘Bed and Toilet Height as Potential Environmental Risk Factors’, Clinical Nursing Research, Vol.
17, No. 1, 50-66 (2008)
http://cnr.sagepub.com/content/17/1/50.abstract [Online 28/3/11]
•
Cochrane Reviews: Cameron ID, Murray GR, Gillespie LD, Robertson MC, Hill KD, Cumming RG, Kerse N
(2010), Interventions for preventing falls in older people in nursing care facilities and hospitals
http://www2.cochrane.org/reviews/en/ab005465.html
•
[Online 28/3/11]
National Ageing Research Institute (Oct 2009), ‘Falls and falls injury prevention activity audit for residential aged
care facilities’
www.nari.unimelb.edu.au [Online 16/5/10]
•
SA Government (2010), Finding of Inquest’
http://www.courts.sa.gov.au/courts/coroner/findings/findings_2010/Hutton_Arthur_John.pdf [Online 28/3/11]
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