Claire Burcham, Lead Falls Nurse - Acute Jane Reddaway, Falls Prevention Lead - Community. Contents

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1 Title: ULTRA LOW BEDS Ref No: 2103 Version 2 Classification: Guideline Directorate: Organisation Wide Due for Review: Responsible for review: Claire Burcham, Lead Falls Nurse - Acute Jane Reddaway, Falls Prevention Lead - Community Document Control Ratified by: Applicability: Care and Clinical Policies Group Jane Viner, Chief Nurse Dr Rob Dyer, Medical Director All staff as indicated - Torbay and South Devon NHS Foundation Trust-wards only Contents 1. Introduction Procedure/Suitability Hiring of 4 4. Monitoring and Auditing.4 5. Training and supervision 4 6. References 4 7. Equality and Diversity.5 8. Appendices 8.1 Ultra-Low suitability procedure-quick reference guide User Manual Cleaning Guidance (Please refer to page 18 of the User Manual Appendix 9. 2) Rental agreement Hiring of ultra-low beds Document Control Information Mental Capacity Act and Infection Control Statement Quality Impact Assessment (QIA) Introduction This policy covers all staff employed by Torbay and South Devon NHS Foundation Trust and sets out the selection, use, maintenance and training of staff to use these beds. Height adjustable beds otherwise known as Hi- Lo or ultra-low beds are electric profiling beds that allow the beds to be lowered to reach the lowest point. Thus minimising the risk of injury to patients at risk of falling or those attempting to get out of bed unaided/unsupervised. The use of these bed frames allows greater independence and security for the patient. Hi lo beds can help to prevent harm from falls particularly for patients with delirium who are at risk of falling out of bed, or when bedrails cannot be used as patients might attempt to climb over them. (NSPA, 2011) Ultra Low beds can help to: Prevent inpatients from sustaining injury arising from a fall from a height Reduce patient s fear of falling Reduce the need for some patient handling tasks Reduce the risk of musculoskeletal injuries to carers and Trust staff Facilitate optimum positioning/comfort and independence and mobility and less bed/chair transfers Assist in the reduction of risks of pressure damage to skin by improved mobility and independence. Collated by Clinical Effectiveness Version 1 (November 2016) Page 1 of 29

2 2. Suitability Each patient should be individually assessed by a suitably qualified nurse or therapist for the most appropriate methods to minimise risk from falling and whether an ultra-low bed is a suitable option to maintain patients safety. The patient: Has been assessed as unsuitable for bedrails Is likely to roll out of bed/has a history of falls/ falling out of bed Is agitated and restless, disorientation- possible delirium/dementia Has alcohol withdrawal Is under 5ft in height Has impaired mobility Is receiving anticoagulants therapy Patient only needs to meet one or more of these criteria. Assessment of using an ultra-low bed The assessments will include: Completion of a patient handling, falls and bedrail risk assessment in which the patient has been identified at high risk and using clinical judgment. A skin assessment to identify the patients skin integrity, risk of pressure damage and need for a pressure relieving mattress. Additional Considerations when using an Ultra-low bed Psychological illness or distress Previous accidents and injuries resulting from falls The environment is assessed to ensure that it is adequately spacious to accommodate the bed and any manual handling requirements. Bedrails should be used when the bed is being moved/ transferred with the patient on it. An ultra-low bed may impact on the patient s ability to engage in rehabilitation Patient s weight and the weight limit of the bed. An ultra-low bed should not be seen as a universal falls prevention solution and should be used in conjunction with other prevention strategies. Is not proposed as a form of restraint to stop patients from mobilising. Mental Capacity issues must be considered and best interest policies adhered to. Also refer to the quick reference guide. (See Appendix 8.1) Other falls prevention strategies may be necessary e.g. sensor mats, supportive observation. Ultra-low beds need to be used safely and appropriately. National Reporting and Learning System (NPSA, 2011) identified a series of incidents related to ultra-low beds including Injuries to patients from floor- level furniture or fitting such as radiators, pipes or lockers Bed frames located close but not flush to a wall, creating a potential for asphyxia entrapment if the patient slipped between the side of a mattress and wall Beds left at working height in error, leading to falls from a height Beds used with bedrails raised, negating any benefit. their purpose Even when ultra-low beds are used correctly in their lowest position, some patients have still sustained serious injury and so any falls must be taken seriously. Collated by Clinical Effectiveness Version 1 (November 2016) Page 2 of 33

3 Procedure The patient must be assessed to be at risk, see suitability above. Patient has given verbal consent and is documented on the patient handling, falls and bedrail assessment. If the patient does not have capacity to consent then a best interest decision is taken involving relatives/carers and documented. The rationale for choosing the bed should be documented in the patient s medical records notes and in the patient handling, falls and bedrail assessment. Communicate the decision to all members of the multidisciplinary team. Bedrails should only be used when the bed is being moved/transferred with the patient on. The Trust s ultra-low bed can be raised to an extra height compared to other beds. This is beneficial for manual handling. Return bed to lowest position when manoeuvre complete and when the patient is unsupervised. Ensure the bed is left in its lowest position to prevent a fall from a height. All staff must ensure that the bed is at the lowest level if the patient is left unattended. Brakes should be applied at all times, except when the bed needs to be moved. The need for an ultra-low bed should be reviewed on a daily basis and noted on nursing records. Consider the type of bed the patient will be using on discharge. Please note: Within Torbay Hospital lift space is tight with the ultra-low bed in the surgical and orthopaedic departments but more spacious in the Hetherington Unit lifts. Please refer to the user manual for guidance. (See Appendix 8.2) Mattress All mattresses must be appropriate to fit dimensions of the bed and do not introduce gaps that could increase the risk of entrapment. (MHRA, 2013) For use with approved mattresses only. These are Invacare larger green mattresses L2000 X W880. Order code SPMSRT5. Manual Handling For manovering patients refer to Manual Handling policy Cleaning Please refer to the manufacturer s recommendations for cleaning. (Appendix 8.3) Decontaminated in the usual way using Antichlor plus wipes as per Trust decontamination policy (Ref: 1112). Maintenance It is staff s responsibility to ensure equipment is used in accordance with manufacturer s instructions. If the bed is not working contact: Standard working hours: MDSS, Medical Electronics Department All other times: Mont calm Rep Mont calm International Head Office on Reporting Incidents All incidents must be reported via the Trusts Adverse Incident Reporting systems, including incidents in which there was potential for harm to an individual even if no injury has been sustained i.e. Near miss Collated by Clinical Effectiveness Version 1 (November 2016) Page 3 of 33

4 3. Hiring In the event that all ultra-low beds are in use, then the Mont Calm Spirit bed can be hired. (other makes have not been approved) During office hours the procedure is a follows: Contact your Matron for authorisation. Obtain an order number through procurement Ring Mont calm Rep on or Mont calm Head Office on to arrange hire of the spirit ultra-low bed. Please refer to rental agreement/delivery note. (See Appendix 8.4) Note the rental costs for short, medium and long term use. The hiring procedure both in and out of hours. (See Appendix 8.5) Outside of office hours, when procurement are not available, contact your on call bleep holder. 4. Monitoring and auditing All servicing and repairs are managed through the medical devices management database. Contact the MDSS, Medical Electronics Department Routine maintenance is based on a risk based model to optimise life costs of the bed. This guideline will be monitored and audited on a regular basis. A full review will take place every two years through the Inpatients Falls Steering Group, unless legislative changes determine otherwise. Auditing will be done when a pattern of adverse incident are reported which reference patient falls from beds. 5. Training Training on ultra-low beds will be included as part of manual handling/falls training covered in mandatory, induction and update sessions. Mont calm will provide 1-2 training sessions per annum. Contact Falls Lead for information on Below is the link to their training video References (NSPA, 2011) The Safe Use of ultra-low beds/signal, reference number MHRA (2013) Safe use of Bedrails. December 2013 Bibliography 1998 (PUWER) Provision and Use of Work Equipment Regulations HSE (2010) Electric Profiling beds in residential and nursing home.rr764 Research Report (1992) The Manual Handling Operations Regulations (2012) Interventions designed to prevent healthcare bed-related injuries in patients (review) The Cochrane Collaboration. MHRA (2013) Safe use of Bedrails. December ed_rails.pdf Collated by Clinical Effectiveness Version 1 (November 2016) Page 4 of 33

5 7. Equality and Diversity This document complies with Torbay and South Devon NHS Foundation Trust s Equality and Diversity statements. 8. Appendices 9. Document Control Information 10. Mental Capacity Act and Infection Control Statement 13. Quality Impact Assessment (QIA) 14. Rapid Equality Impact Assessment Collated by Clinical Effectiveness Version 1 (November 2016) Page 5 of 33

6 Appendix 8.1 A quick reference guide Collated by Clinical Effectiveness Version 1 (November 2016) Page 6 of 29

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27 Appendix 8.4 Rental Agreement/Delivery Note BED TYPE: SPIRIT Bed SERIAL No: CH: DELIVERY DETAILS: HOSPITAL / LOCATION : TORBAY WARD : ORDER NUMBER : PATIENT : Contact : RENTAL SCHEDULE: SHORT TERM: 20 per day, minimum 7 Days (Thereafter 20 per day) MEDIUM TERM: 100 per week, minimum 4 Weeks Delivery / Installation / Collection Charge: 250 TERMS OF RENTAL 1. You have received a copy of Guidance Notes for safe use and made it available to all bed users. 2. Do you require USER INSTRUCTION: YES / NO 3. Please notify cancellation by phone or fax Bed will be Off Rental from midnight of that day. 4. Please return the bed in a clean, uncontaminated condition. 5. You will be charged for any damage to the bed whilst on rental to your ward. 6. PORTABLE APPLIANCE TESTING: This equipment has been tested for electrical safety prior to delivery. 7. If your trust requires equipment to be PAT approved by your engineers before going into service you must ensure that they have been notified accordingly. 8. We accept no responsibility for any accidents or injuries which may occur as a result of the bed being ordered without side rails. SIGNED BY: PLEASE PRINT NAME: DATE: TIME: Collated by Clinical Effectiveness Version 1 (November 2016) Page 27 of 29

28 ULTRA-LOW BED RENTAL PROCEDURE Appendix Collated by Clinical Effectiveness Version 1 (November 2016) Page 28 of 29

29 BED TYPE: SPIRIT Bed SERIAL No: CH: DELIVERY DETAILS: HOSPITAL / LOCATION WARD : ORDER NUMBER : PATIENT : Contact : RENTAL SCHEDULE: SHORT TERM: MEDIUM TERM: : TORBAY 20 per day, minimum 7 Days (Thereafter 20 per day) 100 per week, minimum 4 Weeks Delivery / Installation / Collection Charge: 250 TERMS OF RENTAL 1. You have received a copy of Guidance Notes for safe use and made it available to all bed users. 2. Do you require USER INSTRUCTION: YES / NO 3. Please notify cancellation by phone or fax Bed will be Off Rental from midnight of that day. 4. Please return the bed in a clean, uncontaminated condition. 5. You will be charged for any damage to the bed whilst on rental to your ward. 6. PORTABLE APPLIANCE TESTING: This equipment has been tested for electrical safety prior to delivery. 7. If your trust requires equipment to be PAT approved by your engineers before going into service you must ensure that they have been notified accordingly. 8. We accept no responsibility for any accidents or injuries which may occur as a result of the bed being ordered without side rails. SIGNED BY: PLEASE PRINT NAME: DATE: TIME: Collated by Clinical Effectiveness Version 1 (November 2016) Page 29 of 29

30 9. Document Control Information This is a controlled document and should not be altered in any way without the express permission of the author or their representative. Please note this document is only valid from the date approved below, and checks should be made that it is the most up to date version available. If printed, this document is only valid for the day of printing. Ref No: 2103 Document title: This policy covers all staff employed by Torbay and South Devon Purpose of document: NHS Foundation Trust and sets out the selection, use, maintenance and training of staff to use these beds. Date of issue: 2 December 2016 Next review date: 2 December 2018 Version: 2 Last review date: 24 November 2016 Author: Claire Burcham, Lead Falls Nurse - Acute Jane Reddaway, Lead Falls Nurse - Community Directorate: Organisation Wide Equality Impact: The guidance contained in this document is intended to be inclusive for all patients within the clinical group specified, regardless of age, disability, gender, gender identity, sexual orientation, race and ethnicity & religion or belief Committee(s) approving the document: Care and Clinical Policies Group Dr Rob Dyer, Medical Director Jane Viner, Chief Nurse Date approved: 23 November 2016 Links or overlaps with other All TSDFT Trust Strategies, policies and procedure documents policies: Have you considered using Equality Impact Assessment? Does this document have implications regarding the Care Act? If yes please state: Please select Yes No Does this document have training implications? If yes please state: Does this document have financial implications? If yes please state: Is this document a direct replacement for another? If yes please state which documents are being replaced: Document Amendment History Date Version no. Amendment summary Ratified by: 24 November New Care and Clinical Policies Group Dr Rob Dyer, Medical Director Jane Viner, Chief Nurse 2 December Appendix 8.5 Flowchart amended Care and Clinical Policies Group Dr Rob Dyer, Medical Director Jane Viner, Chief Nurse Collated by Clinical Effectiveness Document Control Information Version 1 (November 2016) Page 1 of 1

31 10. The Mental Capacity Act 2005 The Mental Capacity Act provides a statutory framework for people who lack capacity to make decisions for themselves, or who have capacity and want to make preparations for a time when they lack capacity in the future. It sets out who can take decisions, in which situations, and how they should go about this. It covers a wide range of decision making from health and welfare decisions to finance and property decisions Enshrined in the Mental Capacity Act is the principle that people must be assumed to have capacity unless it is established that they do not. This is an important aspect of law that all health and social care practitioners must implement when proposing to undertake any act in connection with care and treatment that requires consent. In circumstances where there is an element of doubt about a person s ability to make a decision due to an impairment of or disturbance in the functioning of the mind or brain the practitioner must implement the Mental Capacity Act. The legal framework provided by the Mental Capacity Act 2005 is supported by a Code of Practice, which provides guidance and information about how the Act works in practice. The Code of Practice has statutory force which means that health and social care practitioners have a legal duty to have regard to it when working with or caring for adults who may lack capacity to make decisions for themselves. The Act is intended to assist and support people who may lack capacity and to discourage anyone who is involved in caring for someone who lacks capacity from being overly restrictive or controlling. It aims to balance an individual s right to make decisions for themselves with their right to be protected from harm if they lack the capacity to make decisions to protect themselves. (3) All Trust workers can access the Code of Practice, Mental Capacity Act 2005 Policy, Mental Capacity Act 2005 Practice Guidance, information booklets and all assessment, checklists and Independent Mental Capacity Advocate referral forms on icare Infection Control All staff will have access to Infection Control Policies and comply with the standards within them in the work place. All staff will attend Infection Control Training annually as part of their mandatory training programme. Collated by Clinical Effectiveness The Mental Capacity Act 2005 Version 1 (November 2016) Page 1 of 1

32 11. Quality Impact Assessment (QIA) Please select Who may be affected by this document? Patient / Service Users Visitors / Relatives General Public Voluntary / Community Groups Trade Unions GPs NHS Organisations Police Councils Carers Staff Other Statutory Agencies Others (please state): Does this document require a service redesign, or substantial amendments to an existing process? If you answer yes to this question, please complete a full Quality Impact Assessment. Are there concerns that the document could adversely impact on people and aspects of the Trust under one of the nine strands of diversity? Age Disability Gender re-assignment Pregnancy and maternity Marriage and Civil Partnership Race, including nationality and ethnicity Religion or Belief Sex Sexual orientation If you answer yes to any of these strands, please complete a full Quality Impact Assessment. If applicable, what action has been taken to mitigate any concerns? Who have you consulted with in the creation of this document? Note - It may not be sufficient to just speak to other health & social care professionals. Patients / Service Users Visitors / Relatives General Public Voluntary / Community Groups Trade Unions GPs NHS Organisations Police Councils Carers Staff Details (please state): Other Statutory Agencies Collated by Clinical Effectiveness Quality Impact Assessments Version 1 (November 2016) Page 1 of 1