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PATIENT SAFETY
The impact of hospital beds on patient safety
When Leicester Hospital and Blackpool Teaching Hospitals NHS Foundation Trust sought to review their beds and mattresses, they explored a range of ultra-low and assisted mobilisation beds. Enabling patients to sit up, progress them into a full cardiac chair position, the system was considered a valid alternative to hoisting.
Leicester General Hospital’s (LGH) Intensive Therapy Unit (ITU) provides care to unstable or critically unwell patients. Patients may be admitted as an emergency due to serious illness, injury or urgent surgery, or admission may be planned after routine but complex surgery. Care at the unit is co-ordinated and
delivered by a multidisciplinary team led by a consultant in critical care medicine, consisting of critical care doctors, nurses, physiotherapists, dieticians, pharmacists and speech and language therapists. The critical care team works in conjunction with other specialists, such as microbiologists, surgeons, radiologists and physicians to provide all aspects of care for critically ill patients. The benefits of early mobilisation of
patients in ITU are well documented and include decreased length of stay, decreased weaning times, reduced delirium and improved functional outcomes. The stages of early mobilisation can include side sitting, chair sitting, standing and ambulating. In ITU at LGH a number of potential
challenges achieving these stages for certain patients had been identified. Firstly, the bed and dynamic mattress combination did not allow shorter patients to place their feet on the floor when sitting or attempting to mobilise. One solution was to deflate the mattress, but once deflated, there would often be discomfort and there was little protection for existing wounds or fragile skin, resulting in the potential for serious
preventable harm being caused. Secondly, patients who were unable to
be moved to the side of the bed were often hoisted into chairs. Hoisting patients who are ventilated and attached to multiple lines carries significant risk so often required up to
The indignity, prolonged effort, discomfort and fear of damaging skin associated with manual hoisting may cause patients to panic at the prospect of being moved in this manner. Paul Ayrton, manual handing advisor, Leicester General Hospital
SEPTEMBER 2018
four members of staff to complete the hoist. Paul Ayrton, manual handing advisor at
LGH, said: “Due to the risk involved, hoisting on the ITU is always seen as a last resort but often it is the only option available to patients to facilitate treatment or aid their early mobilisation. “Attempting to move a high dependency
patient into a normal sitting position following this mobilisation protocol is incredibly time and resource intensive and would require at least three members of staff to correctly and safely manoeuvre a ventilated patient. Often, it would take four members of staff anywhere between half an hour and an hour and a half. That of course draws clinicians away from their routine care
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