Guidance for Assessment and Provision - NAEP UK

1 Bed rail Provision Guidance for Assessment and Provision Clinical & Prescriber Support Special Interest Group Issue 1: June 2011 Page | 2 NAEP Clinical & Prescriber Support Special Interest Group Index: Page: The NAEP Clinical & Prescriber Support Special Interest Group 3 Purpose of the Guidelines Using the Guidelines Introduction 3 3 3 - 4 Terminology 4 The Guidelines Pathway 5 Section 1 Current Situation and Risk Assessment 6 Section 2 Alternative Solutions 7 Section 3 Identification of Appropriate Equipment A) Bed Rails B) Bumpers 8 9 Section 4 Action Plan and Provision 10 Section 5 Fitting 11 Section 6 Monitor and Review 12 Appendix 1 DO NOT S 13 Appendix 2 Assessment Checklist Tool 14 - 17 Appendix 3 Appendix 4 Outcome of Assessment /Action Plan Review Checklist 18 19 Appendix 5 Reference Links / Reading List / 20 Page | 3 NAEP Clinical & Prescriber Support Special Interest Group The Clinical and Prescribers Support Special Interest Group The group membership includes qualified Occupational Therapists, Nurses and Physiotherapists from across the UK with specialist knowledge of community equipment and experience of working closely with Community Equipment Services.

2 Using professional expertise and research, the group supports clinicians and prescribers and through them providers of Community Equipment Services to facilitate best practice in equipment Provision to the end user. The group develops clinical Guidance that provides Assessment tools to assist with the selection process for the most suitable equipment to meet the needs of the end user. Health and safety, design, training, maintenance and clinical need are considered. Purpose of the Guidance To provide: Clinical Guidance on the Assessment process for bed rails and accessories to meet individual needs. Consistency in approach to Assessment and Provision as a basis of good practice. A reliable and relevant point of reference.

3 Using the Guidelines The Guidance can be utilised as a benchmark to compare and develop local Guidance , taking into account existing policies and procedures Sections one to six provide points to be considered and are to be used in conjunction with the bed rail Assessment checklist in appendix 1 Introduction There have been a number of incidents and fatalities involving bed rails that have led to injury or death and consequently a number of British and European standards and recommendations produced. The latest standard represents current thinking in Basic Safety and Essential Performance of the Medical Bed and is the combined effort of working groups from the International Electrotechnical Commission (IEC) and ISO.

4 This British European Standard - 60601-2-52:2010 is identical to the IEC 60601-2-52:2009 and supersedes BE EN 1970:200 and BS EN 60601-2-38:1997 both of which will be withdrawn in April 2013. Manufacturers of medical beds and bed rails are working towards meeting these standards for April 2013. As a result of the new standards the NAEP guidelines for bed rails will reflect relevant changes to the specific measurements of the space at the head foot ends of the bed from 250mm to 318mm. Page | 4 NAEP Clinical & Prescriber Support Special Interest Group Bed rails are used in a variety of settings to reduce the risk of falls from a bed; however they are not intended to limit freedom of movement, meant to be used to restrain or to be used as grab rails.

5 All prescribers of equipment should be made aware of the hazards associated with the use of bed rails and how to use them safely. But it should be noted that the MHRA (Dec; 2006) advises most bed rails are designed only to be used with adults and adolescents, not for children under 12 or small adolescents and adults. Using bed rails with children Risk assessments should always be carried out on the suitability of the bed rail for a child or small adult and reference should be made to manufacturers Guidance . There ARE NO published standards on bed rails for children but there are other standards addressing the entrapment risk (BS EN 12182) which suggests that the maximum space to avoid entrapment of children s heads in static equipment is should also be given to the suitability of the bed.

6 Many of the alternatives to bed rails can be used with children. 60601-2-52:2010 (page 52), recognises that the definitions of terms adult and child are based on physical characteristics. The dimensional requirements of this particular standard are based on anthropometric data based on PATIENTS ranging in physical size from a 146 cm tall female to a 185 cm tall male. For BEDS intended for use with PATIENTS outside this range, all dimensional characteristics in this particular standard should be adjusted accordingly. Terminology For the purpose of this document the term bed rail will be adopted, although other names are often used, such as bed side rails, side rails, cotsides, and safety sides.

7 (MHRA - Device Bulletin - Safe Use of Bed Rails. December 2006: Page 5 section ) Bed rails should not be confused with bed grab handles, bed sticks or bed levers which are designed to assist a person to get in and out of bed and move in bed. They are not designed to prevent a person falling from their bed and should not be used as bed rails. (MHRA - Device Bulletin, Safe Use of Bed Rails, December 2006: page 6 section Bed rails can be classified into two basic types: As an optional accessory supplied by the bed manufacturer Or supplied separately for use on domestic divans or metal framed beds Page | 5 NAEP Clinical & Prescriber Support Special Interest Group Pathway - To Assist in the Assessment for the Provision of Community Bed Rails or Alternative Solutions)

8 Current Situation & Risk Assessment Section 1 Alternative Solutions Section 2 Identification of Bed Rails Section 3 Monitor and Review Section 6 Outcome of Assessment ACTION PLAN and Provision Section 4 Fitting Section 5 Page | 6 NAEP Clinical & Prescriber Support Special Interest Group Section 1 Current Situation and Risk Assessment Consider:- Person: Medical condition and future implications Medication changes in physical or medical state Ability to transfer Consider how the person moves in bed Falls - reasons for Care needs Continence issues toileting in the night Behaviour and cognitive state anxiety / fear of falls / confusion / agitation or lack of insight Height and weight Capacity to give consent.

9 See references for England Scotland Wales and Northern Ireland Repetitive / involuntary movements Additional considerations personal choice Formal and informal Carers: Age and ability to provide care and use equipment Physical ability Cognitive ability Moving and Handling Additional considerations personal choice Current situation: The person s wishes Past and existing equipment type of bed, depth and type mattress, bed lever grab rails by the bed Care Provision Present location ; hospital / home / care home Other medical devices to consider , peg feed, medical equipment, ventilator or oxygen tubing. Financial Implications to person and organisations: Injury to person / formal / informal carer Alterations to care package Avoidance of admission to hospital or care home / delayed discharge Page | 7 NAEP Clinical & Prescriber Support Special Interest Group Section 2 The Alternative Solutions to Provision of Bed Rails Examples: Inflatable systems Side wedges Extra low Variable height Extra low Variable height bed with crash mat Internal foam surrounds Sensory/motion/pressure alarms NB all the above require risk assessments Consider.

10 Re-enablement / Rehabilitation Suitability of existing bed for fitting accessories Condition and type of mattress extra dense foam Falls related to transfers Person s wishes Compatibility of combinations of equipment. mattress systems / mattress elevator / pillow lifter / mobile hoist / standing hoist Informal carers and family members understanding use and limitations of alternative solution Page | 8 NAEP Clinical & Prescriber Support Special Interest Group Section 3 Selection of Appropriate Equipment Please also see appendix 1: DO NOT A) Bed rail Take into account: Combination of person, mattress, bed and proposed bed rail Check bed rail meets current regulations for dimensions Local specifications of equipment see example below Local agreements Example Template for local use Manufacturers Basic features Additional Features SWL (safe working load) Other Supplier / s Length Height Gaps between bars extendable Stone / kg Compatibility Page | 9 NAEP Clinical & Prescriber Support Special Interest Group B) Bed rail Bumpers Bumpers are primarily used for preventing impact injuries, but in some instances they can reduce the potential for entrapment.