The benefits of bed turning systems for clients with complex physical needs
by Monica Iofciu
The aim of this article is to provide the reader with a comprehensive understanding of bed turning systems including the assessment and decision-making process that an occupational therapist will go through when recommending them for their clients.
What is a bed turning system?
A bed turning system is a specialised medical device used to reposition clients who are unable to turn themselves and may spend extended periods of time in bed. This client group is at risk of developing pressure sores which can lead to serious complications if left untreated.
In this article, we will explore some of the common bed turning systems, their benefits, their contraindications and the risks associated with their use.
Types of bed turning systems
There are 4 main types of bed turning systems that an OT may consider:
-
Sliding sheet systems These use a specially designed sheet that slides underneath the client, allowing them to be turned and repositioned without manual lifting or rolling.
-
Air-assisted systems These use air pressure to lift and turn the client, reducing the amount of physical force required by the caregiver as they are semi-automated thus less labour-intensive.
-
Motorised systems These are fully automated and use a motor to move the bed and turn the client. They are recommended for clients who require frequent turning and repositioning and for caregivers who may have limited physical strength. These systems can be programmed to turn clients at predetermined intervals and can detect pressure points and adjust the client's position accordingly.
-
Other systems These include prone positioning systems are designed to improve oxygenation in clients with acute respiratory distress syndrome and combination systems combine two or more types of bed turning systems and tend to be used more in acute settings.
Benefits of Bed Turning Systems
- Even pressure distribution leading to lower risk of pressure sores, less pain and discomfort and better sleep.
- Reduced need for manual turning, allowing healthcare professionals to spend time on other tasks.
- Safe method of turning clients with complex manual handling needs.
- Prevention of costly medical complications associated with prolonged bed rest: less hospitalisations and shorter hospital stays.
- Lower cost of packages of care.
What are the contraindications of using bed turning systems?
The below are considerations that the OT will make when recommending a bed turning system:
- The rotation and movement of the bed may interfere with necessary monitoring or procedures, could cause discomfort or even harm to the client with unstable or critical medical conditions.
- Clients may not be able to tolerate the pressure and movement associated with bed turning systems and there may be additional risks associated in cases of recent surgeries or injuries, spinal cord injuries, pregnancy, skin or tissue conditions.
- The system may not be able to support or evenly distribute the weight of morbidly obese clients or distribute the weight evenly.
- Clients who are experiencing uncontrolled pain may not be able to tolerate the movement or positioning involved in using a bed turning system. In these cases, it may be necessary to explore alternative pain management methods or to postpone the use of a bed turning system until pain is under control.
- Clients with severe respiratory or cardiac conditions may not be able to tolerate the positioning or movement involved in using a bed turning system. In these cases, it may be necessary to explore alternative positioning methods that are less strenuous or that can be adjusted to meet the client's needs.
- It is important to discuss client preferences and comfort with healthcare providers before implementing a bed turning system.
- Bed turning systems require communication between the client and caregiver to ensure proper positioning and comfort.
Risk assessment for turning bed systems
All bed and bed furniture provision should be thoroughly risk assessed and documented and bed turning systems are no exception. A detailed risk assessment should be completed covering the client, the environment and product.
- The turning bed system may cause the client to become trapped or caught between the bed and the turning mechanism. The risk of entrapment is high, particularly for clients who are confused or disoriented. Turning bed systems should have built-in safety features, such as sensors or alarms and clients should also be monitored closely during the turning process.
- Clients who are not properly secured on the turning bed system may be at risk of falls or injuries. To mitigate this risk, the bed should be equipped with safety features to ensure that the client is secure during rotations. The turning bed system should be used only by trained personnel.
- While the turning bed system is designed to reduce the risk of skin shearing, improper use or prolonged periods of rotation can still lead to skin breakdown. Healthcare providers should closely monitor clients for signs of skin irritation or breakdown, and adjust the rotation schedule as needed.
- Malfunctions or breakdowns of the equipment can result in injury or discomfort for the client. Regular maintenance and testing of the system can help to prevent equipment malfunctions and ensure proper functioning.
- Some clients may experience discomfort or nausea during rotations on the turning bed system. Healthcare providers should closely monitor clients for signs of discomfort or adverse reactions, and adjust the rotation schedule or angle as needed to minimize discomfort.
- Improper cleaning or disinfection of the turning bed system can increase the risk of infection for clients. Healthcare providers should follow strict protocols for cleaning and disinfecting the system between clients, and regularly inspect the system for signs of damage or wear.
Can bed turning systems be used on double beds?
Bed turning systems are typically designed to be used with profiling beds, which are typically single beds.
Double beds are larger and heavier than standard hospital beds, which may make it difficult to rotate the bed and the client safely and effectively.
Bed turning systems typically require a certain amount of clearance around the bed to function properly. If the double bed is located in a small room or in a crowded area, it may not be possible to use a bed turning system safely and effectively.
If two clients of different weights are sharing a double bed, the rotation of the bed could be uneven, which could cause discomfort or even injury.
Clients in a shared double bed may have different medical needs, preferences or needs for privacy and personal space. The use of a bed turning system may interfere with these different needs and preferences, particularly if one client needs to be turned more frequently than the other. The rotation of the bed could cause the other client to be jostled or uncomfortable, which could lead to disruptions in sleep and potential safety risks.
In general, if a bed turning system is needed for two clients sharing a double bed, it may be necessary to use two separate bed turning systems or to consider alternative options.
Cost implications
Basic manual bed turning systems are less expensive than more advanced motorised systems that have automated controls and sophisticated features. Additionally, some bed turning systems may require additional accessories or components, such as specialized mattresses or air cushions, which can add to the overall cost. Other factors that may influence the cost of a bed turning system include the warranty period, maintenance and repair costs, and installation fees. Generally, bed turning systems prices range from several thousand to tens of thousands of pounds.
Bed turning systems can potentially reduce the need of double handed packages of care or 24 hours care. For example, if a package of care costs £20 per hour, four care calls of one hour cost £80 per day, £560 per week and £29,120 per year. A double-handed package of care would cost £58,240 per year.
A live in carer would cost £1600 per week, £83,200 per year. But if a client needs to be turned every two or four hours, more care calls will be required during the day and also a waking night carer which increases the prices further. As a general guidance, a waking night carer costs £120 per night thus £42,720 per year. In the case of complex manual handling, two carers would be required.
A nursing home bed costs over £850 per week and £44,200 per year.
Whilst the cost of a bed turning system is a significant investment, it can provide substantial benefits in terms of improved client comfort, reduced risk of complications, and better outcomes for clients as well as significant financial savings due to reduced hospital stay, reduced staffing needs, reduced equipment and treatment costs, prevention of pressure ulcers, improved client comfort, and improved staff efficiency.
Conclusion
Overall, bed turning systems are beneficial for clients who are spending long periods of time in bed or those who are unable to turn themselves over night. When considering bed turning systems, it is important to carefully evaluate each client's individual needs, medical history and preferences. While the cost of these devices can be significant, it can lead to significant cost savings in the long run by preventing complications, reducing hospital stays, improving client comfort, and increasing staff efficiency. Nonetheless, it is important to assess and mitigate the potential risks associated with their use. Proper training, equipment maintenance, and client monitoring can help to ensure safe and effective use of turning bed systems in clinical settings and home settings. Occupational therapists are able to assess the needs of the clients and also support with the equipment provision and familiarisation of the carers. Case managers can request an assessment for a bed turning system if they felt it might be beneficial for their client by contacting TOTP.
Further reading
https://www.nhs.uk/conditions/pressure-sores/
https://www.nice.org.uk/guidance/qs89
https://www.nice.org.uk/guidance/cg179/chapter/1-recommendations
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4792991/
