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Installing electrically operated beds

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A pressure ulcer can be defined as a skin wound which occurs following disruption to the blood supply due to pressure, shearing and/or friction (Dealey, 1997). The grading of pressure ulcers ranges from grade 1 (skin intact, but redness present, blistering, non-blanching hyperaemia) to grade 4 (full thickness skin loss with extensive destruction, necrosis and damage of muscle, bone and supporting structures). The higher an ulcer’s grade, the more severe are the implications for treatment, financial costs and impact on patient recovery.

Abstract

VOL: 99, ISSUE: 13, PAGE NO: 71

Jayne Richards, BA, RGN, is tissue viability nurse specialist Gateshead Health NHS Trust and Gateshead PCT

Kath Lowery, BSc, RMN, is research fellow, Gateshead Health NHS Trust;Bev Atkinson, MSc, BSc, RGN, is deputy director of nursing and midwifery at Gateshead Health NHS Trust

A pressure ulcer can be defined as a skin wound which occurs following disruption to the blood supply due to pressure, shearing and/or friction (Dealey, 1997). The grading of pressure ulcers ranges from grade 1 (skin intact, but redness present, blistering, non-blanching hyperaemia) to grade 4 (full thickness skin loss with extensive destruction, necrosis and damage of muscle, bone and supporting structures). The higher an ulcer’s grade, the more severe are the implications for treatment, financial costs and impact on patient recovery.

 

Many factors may contribute to the development of pressure ulcers including general health, nutritional and fluid intake, and friction and shear. The moving and handling of patients in bed is thought to increase the risk of pressure damage due to shearing and friction (Gebhardt, 1995), while the manual moving of patients, which involves stooping, twisting, reaching and bending, increases the risk of staff injury (RCN, 1996).

 

The majority of hospital beds are standard hydraulic, foot-pump operated devices with a flat base and pull-out backrest. Patients using these tend to slide down the bed (Mitchell, 1998), and often have difficulty adjusting their position. In contrast, electrically operated profiling beds enable patients to move themselves independently, reducing the risk of staff injury and pressure ulcer development (Mitchell, 1998).

 

Electrically powered beds with variable height controls are described as ‘beds of choice’ for patients confined to bed (King’s Fund, 1998). However, there are limited clinical trials on their effectiveness (Keogh and Dealey, 2001). Clinical evidence suggests that they can have a positive impact on the health of both patients and staff with a potential cost savings to the NHS (Preece, 1999).

 

The project

 

The aims of introducing electric profiling beds in Gateshead Health NHS Trust were to:

 

- Reduce the prevalence of pressure damage for at-risk patients;
- Improve patients’ comfort and independence;
- Minimise the risks of back injury among staff, by reducing manual handling.

 

The renewal of a therapy bed contract offered an ideal opportunity to review the current expenditure and introduce a ‘total bed management system’, replacing existing beds with electric profiling beds. The tissue viability nurse and the deputy director of nursing and midwifery facilitated negotiations between the supplies, finance and the estate departments. The primary aim was to ensure that the new therapy bed contract would improve patient care while remaining within budget.

 

To effect positive change it was essential that the service managers and clinical leaders from medicine, surgery, orthopaedic and care of older people were involved via a series of meetings. Front-line staff were engaged through study days. The tissue viability nurse along with the ergonomics team trained all nursing staff and ancillary and allied health professionals including domestics, porters, engineers, X-ray and theatre staff in the operation of the new electric profiling beds. A resource file containing useful hints, troubleshooting guides and contact numbers - should there be any problems with the beds - was given to every ward.

 

Effects of the electric profile beds

 

Before the implementation of the electric profiling beds, a full prevalence study was carried out on pressure damage to patients within the hospital. Its prevalence before the beds were introduced was 11 per cent; this dropped to six per cent after their introduction.

 

An initial follow-up survey of pressure ulcers detailing patient demographics, clinical area, new and old wounds and wound grades was carried out one month following introduction of therapy beds. Detailed analysis revealed that in the acute hospital, which includes medicine, orthopaedics, surgical wards and intensive care, a prevalence of eight per cent was reduced to four per cent following introduction of the electric profiling beds.

 

In the elderly care unit the overall prevalence rates of pressure ulcers before the beds were introduced was 12 per cent, compared with 8.9 per cent after. This drop was not as significant as it was in the acute wards and may reflect the higher number of pressure ulcer risk factors associated with older people.

 

Among the patients aged over 65 years throughout the trust, the prevalence of grade 3 pressure ulcers and above reduced from 6.6 per cent to 3.8 per cent following the introduction of the bed system.

 

A cross-sectional sample of therapy bed users and staff were surveyed to evaluate subjective benefits of the beds six months after their introduction. Bed users highlighted that the new beds gave them more independence and personal control, compared with the traditional hospital beds. Staff noted that the reduced moving and handling improved their working lives.

 

Conclusion

 

The introduction of electric profiling beds was carried out causing no disruption to patients or staff. There have been many beneficial outcomes, including a reduced incidence of pressure ulcers, reduced severity of ulcers that have occurred, improved patient independence and health benefits for staff.
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