Changing bed width may lower risk of falls in long term care

by | Jun 21, 2012

Healthcare practitioners are discovering that the concepts of ergonomics can provide much value when used to create safer environments in healthcare facilities. Through the application of ergonomic principles, progress has been made in healthcare safety, benefiting both patients and caregivers; however, the long-term care (LTC) environment continues to expose residents to many hazards, despite striving to provide quality care to the aging population. One such hazard, especially among LTC residents with deteriorating functional abilities, is falls. Prevention of resident falls demands serious attention, and healthcare practitioners need to continue to seek effective solutions to reduce falls risk in this population.

A new study examines the issue of falls from bed, a major contributor to the overall falls problem and sheds light on how equipment design improvements can reduce risk of falls among high-risk populations.

Residents’ high risk of falling and the frequent occurrence of falls in the LTC setting have been well documented. It has been estimated that 45% to 70% of residents fall each year, of whom 50% experience multiple falls.It has also been determined that older adults residing in LTC settings are two to three times more likely to experience multiple falls than their community-dwelling counterparts. Approximately 50% of the falls that occur in LTC settings involve falling from bed. Bedside falls are associated with significant physical and psychological complications, including hip injuries, fractures, immobility resulting in muscle weakness, functional disability, and psychological distress, such as depression and fear of falling. They are also associated with an increased risk of subsequent falls.

In addition to their serious health risks, falls pose a significant financial burden to healthcare delivery systems. Currently, containing the cost of healthcare is a major objective for society, and reducing falls among elders offers opportunities for cost savings. A study of people aged 72 years and older found that the average healthcare cost of a fall injury was $19,440, which included hospital, nursing home, emergency department, and home healthcare, but did not include physicians’ services. The total direct cost of all fall injuries for people 65 years and older in 2000 was slightly more than $19 billion.

Falls sustained by residents in post-acute care facilities do not have a single cause, but result from the interaction of several risk factors. Bed falls are common among residents with lower extremity dysfunction, cognitive disorders, or on medications that impair their ability to rise up and move independently. Elevated bed heights and soft mattresses can contribute to falls when a resident is trying to get out of bed. Bladder dysfunction can lead to more frequent attempts to leave the bed, increasing falls risk. When new residents are placed in unfamiliar surroundings and in beds with casters that are set at a different height and width than what they are accustomed to, risk of falls increases. Studies involving the implementation of an interdisciplinary program that included staff education, environmental modification, exercise programs, provision of aids and free hip protectors, drug regimen reviews, and post-fall problem-solving conferences significantly decreased the risk of falls and hip fractures among institutionalized elders.

Implementation of resident fall prevention programs has been on the safety agenda of many organizations over the years. Current programs are usually strong at identifying individuals at risk of falls, but improvements are often needed when it comes to finding and implementing effective solutions. Managing falls among a population with decreasing functional abilities is a complex and challenging endeavor, and one that requires a multifactorial approach. The first step in this approach is to identify the key individual components of the set of multifactorial solutions. The next step is to implement each of these individual components using an appropriate knowledge base and any available technology and expertise.

Considering both the extrinsic and intrinsic risk factors related to falls in LTC settings, applying the concepts of ergonomics to optimize furnishings in the physical care environment might be one of the most effective individual components in the multifactorial solution. The most important furnishing within the LTC care environment is the bed system provided for the resident. Understanding the needs of the resident through a proper assessment, and matching available bed system features to those needs, might be the most important individual solution component when devising a multifactorial solution to address the risk of resident falls.

Accepting that bed systems are important in the environment of care, consider some of the history that has dictated traditional healthcare bed design, specifically healthcare bed width. Traditionally, beds placed in post-acute and LTC facilities have surfaces that are 35 inches wide. This seems to have originated from the need to use beds as a transport device, which requires that they fit through a standard 36-inch wide doorway. Users of these beds are moving around on and repositioning themselves on a surface that is significantly narrower than common consumer products, which range from 39 inches for twin beds to up to 60 inches for queen-sized beds. According to an article by Banks,18 patients often fall from bed while repositioning or reaching for an object placed on a side table. The large difference of bed width noted between consumer and healthcare products may directly contribute to the risk of falling from bed, as the traditional LTC products provide less surface area for movement and repositioning.

When considering the ergonomics of well-designed healthcare bed systems, there are many design characteristics to consider, including bed surface height for egress, ambulatory assist handles for egress, bed exit alarms, bed surface options, and many other frame and surface characteristics. Although all of these design features are important to consider, a detailed discussion of each of them is beyond the scope of this article. Our report hones in on the specific design criteria of bed surface width, which we assessed in a small study.

Bed systems are an important consideration in healthcare environments, including LTC settings, and proper thought should be given to selecting appropriate beds for a post-acute facility. Input should be sought from various disciplines within the facility, including clinical, rehabilitation, risk management, engineering, and purchasing personnel. Good planning when making new bed acquisitions can pay big dividends for a minimal investment. If a wider surface can prevent a resident from falling out of bed and if a lower bed height can reduce injury severity when a fall occurs, many negative potential outcomes can be avoided. While it may seem impractical or expensive to obtain wider beds, options are currently available to increase bed width with little added cost. For example, bed frame extension kits can be purchased for some bed frame models, necessitating that only the mattresses are changed. When making bed system selections, facilities should make the effort to seriously consider how to best match bed system design and function to the needs of their resident population, as having proper bed systems can help LTC facilities meet the objective of maintaining a safer environment while fostering high-quality care.

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