Please note if you are a provider registered with CQC, and with premises located in England, CQC is the relevant regulatory body for patient safety matters Show
What is the risk?Bed rails, also known as side rails or cot sides, are widely used to reduce the risk of falls. Although not suitable for everyone, they can be very effective when used with the right bed, in the right way, for the right person. However, accident data shows that bed rails sometimes don't prevent falls and can introduce other risks. Poorly fitting bed rails have caused deaths where a person's neck, chest or limbs become trapped in gaps between the bed rails or between the bed rail and the bed, headboard, or mattress. Other risks are:
Bed rails are 'medical devices', which fall under the authority of the Medicines and Healthcare Products Regulatory Agency (MHRA). MHRA enforces the Medical Devices Regulations and the General Product Safety Regulations to ensure medical devices are acceptably safe. MHRA guidance on the 'Safe Use of Bed Rails' (Device Bulletin DB 2006(06)) and details of when and how to contact them can be found on the MHRA website. What do you need to do?When bed rails are used during the course of a work activity, such as in a care home or hospital, the employer or self-employed person providing them must ensure that they are safe Risks identified during inspection include:
Bed rails need careful management. Users should ensure:
HSE advises users to take into account the dimensions in British standard BS EN 1970:2000 (to be withdrawn on 1st April 2013) and BS EN 60601-2-52:2010 when assessing risk and ensuring correct fitting. Manufacturers and suppliers of bedrails also have a duty to ensure that equipment is safe for use and you should refer to their instructions. IntroductionBedpan use in today's society is not that different from use in the 18th century. Bedpans are a way of addressing elimination concerns when the traditional toilet is not an option due to high risk of injury or debilitating illness in sick, bed-confined individuals.[1][2][3] There are 2 types of bedpans: regular or fracture. The regular bedpan is larger than its fracture counterpart. The fracture pan has one flat end for ease of use with specific patient populations: i.e., hip fractures, hip replacements, or lower extremity fractures. Bariatric bedpans are available up to a 1200-pound (544-kg) capacity.[4] Using the toilet may be a source of discomfort and embarrassment among all genders. Semi-private rooms or shared wards and hospital overcrowding are a challenge regarding patient privacy.[5][6] IndicationsMedical necessity may warrant the use of a bedpan, for example as with immobile patients with the following concerns:
EquipmentBedpans come in regular size or a smaller, fracture pan. Bedpans are chosen based on diagnosis, patient comfort or preference and if any contraindications exist for using the regular size such as a fracture. Gather all supplies before you start the procedure.[7][8] Supplies
TechniquePlacing a patient on a bedpan requires a special technique and is reserved for those that are on bed rest per a health care provider order or discretion. Follow any preset institutional policies on the use of a bedpan in a clinical setting. A patient that can assist with care by raising their hips is approached differently than a patient that cannot lift their hips due to surgical considerations, fractures, or other contraindications. In both cases, ensure the patient is pulled up as high as they can be on the stretcher or bed. If they can assist with raising their hips, then raise the head of the bed at least thirty degrees. Positioning in this Semi-Fowler's position allows for anatomical support and facilitates ease of defecation or urination by assuming a natural position for these bodily functions. According to a 2003 study, body positioning has a significant influence on intestinal gas propulsion and transit times with gastric flow being faster in the upright position than when supine [Dainese, Serra, Azpiroz & Malagelada, 2003]. Steps
ComplicationsComplications surrounding bedpan use may include constipation, embarrassment, discomfort, and loss of dignity due to inadequate patient privacy. Privacy and Dignity An audit conducted in 2010 addressed "Toilet Privacy in the Hospital" [Logan, 2012]. Comments from patients and staff highlighted certain critical areas of concern in regards to toileting, privacy, and confidentiality. Areas of interest amongst patients while toileting consisted of specific vital points, for example, call light out of reach or cord too short, slow response to call light, lack of hand hygiene after toilet use for the patient, curtains that would not close properly and lack of privacy while toileting. Suggestions were made to improve patient privacy while defecating or urinating such as better signage [Logan, 2012]. Constipation Another complication of bedpan use can be constipation. An environment that lacks appropriate privacy may force a patient to feel that it is inconvenient to use the toilet, thus resisting the urge to defecate. If defecation is discommoding, the desire to defecate prompts voluntary contraction of the external sphincter and puborectalis muscle. This urge dissipates, and the rectum accommodates to hold more stool (as cited in Sun, Read & Miner, 1990)[Rao et al., 2016]. A study conducted between 2003 and 2004 on stroke patients found that (55.2%) developed new-onset constipation within a month after the first stroke [Su et al.,2009]. The study went on to conclude that patients with moderate severity of stroke (NIHSS 4 -11) on arrival had a higher incidence of bedpan use, thus poor outcomes at 3 months post-stroke as a result of the added complication of constipation. The study recommended a suitable environment for defecation for stroke patients to curb new-onset constipation and improve patient outcomes [Su et al., 2009]. A study sponsored by the Italian Space Agency analyzed ten healthy men for the effects extended bedrest had on the body as it related to new onset constipation. The men were studied for 35 days in a controlled environment on strict bedrest with bedpan use for defecation in a lying, head down position. At the end of the study, 60% had new onset functional constipation [Iovino et al., 2013]. Clinical SignificancePatients in need of toileting with the use of a bedpan can impose specific inherent risks, thus should be used with the knowledge of the emotional and physical implications in a clinical setting. This task should not be used for provider convenience, but with certain criteria for client selection to meet the standard of care. Staffing challenges may lead to delays in answering call lights and providing toileting assistance. These delays of care may place a patient at risk for falls and incontinence, thus contributing to emotional and physical duress. Missed care opportunities lead to a decrease in patient satisfaction and overall perception of care. Therefore reimbursement of care may be affected by a trickle-down effect with negative patient satisfaction scores.[9][10] Enhancing Healthcare Team OutcomesThe bedpan is a useful medical equipment that is used frequently in hospitals. The nurses are primarily involved in the management of the bedpan with assistance from the therapists. The important features of bedpan are not only to provide a functional use for the patient, but comfort and privacy. If a bed pan is to be used, it should be for a short duration. there are countless cases of pressure sores, ulcers and neuropathy from patients being left too long on the bed pan. Unfortunately, managing the bed pan is not easy for the nurse when patients are obese and have limitations in movement; plus spillage of the contents is a major problem. Review QuestionsFigureBedpan examples, fracture pan included. Contributed by Tammy J. Toney-Butler, AS, RN, CEN, TCRN, CPEN References1.Kozak A, Freitag S, Nienhaus A. Evaluation of a Training Program to Reduce Stressful Trunk Postures in the Nursing Professions: A Pilot Study. Ann Work Expo Health. 2017 Jan 01;61(1):22-32. [PMC free article: PMC6824526] [PubMed: 28395308] 2.Farrington N, Hill T, Fader M, Richardson A. Supporting women with toileting in palliative care: use of the female urinal for bladder management. Int J Palliat Nurs. 2016 Nov 02;22(11):524-533. [PubMed: 27885906] 3.Inauen P, Wittwer Y, Saxer S. [Research report: urination tubes instead of bedpan]. Krankenpfl Soins Infirm. 2011;104(10):22-3. [PubMed: 21991769] 4.Saxer S, Gattinger HA, Dopler R, Scheffel S, Werner B. [Frequency of using the bedpan in acute care]. Pflege. 2011 Oct;24(5):297-302. [PubMed: 21964933] 5.Pellatt GC. Anatomy and physiology of urinary elimination. Part 1. Br J Nurs. 2007 Apr 12-25;16(7):406-10. [PubMed: 17505362] 6.Bekhøj L, Eltzholtz AB. [Hygiene nurse--when bedpan boilers break down]. Sygeplejersken. 1997 Aug 22;97(34):26-7. [PubMed: 9386588] 7.Sonoda T, Masumoto T. [Innovation in nursing equipment. A bathroom for the orthopedic department]. Kango Gijutsu. 1980 Oct;26(14):1934-5. [PubMed: 6904593] 8.BRANSON HK. THE BEDPAN RECONSIDERED. Hosp Manage. 1964 Jul;98:78 PASSIM. [PubMed: 14154394] 9.Guay M, Dubois MF, Desrosiers J. Can home health aids using the clinical algorithm Algo choose the right bath seat for clients having a straightforward problem? Clin Rehabil. 2014 Feb;28(2):172-82. [PubMed: 23897948] 10.Putre L. Lifting spirits with bedpan shuffleboard. Hosp Health Netw. 2013 Jan;87(1):63. [PubMed: 23413624] When the nurse is making an occupied bed back/safety indicates that the nurse should?6. When the nurse is making an occupied bed, back safety indicates that the nurse should initially: a. raise the bed to the proper working height before starting.
When assisting a person to move to the head of the bed you should?Put one foot forward as you prepare to move the patient. Put your weight on your back leg. On the count of three, move the patient by shifting your weight to your front leg and pulling the sheet toward the head of the bed. You may need to do this more than once to get the person in the right position.
What is a vest protective device?A safety vest is an article of personal protective equipment that's designed to have high visibility and reflectivity.
Which of the following is a safe use of a hospital bed?Which of the following is a safe use of a hospital bed? Check that side rails are secure and sturdy. What is the most common type of injury experienced by health care workers?
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