Elevation of the bed head
A new recommendation featured in the latest Pressure Injury Guidelines is that there is a need for the head section of the bed to be as flat as possible with consideration to the individual’s clinical needs and comfort (EPUAP/NPIAP/PPPIA: 2019). When elevating the head of the bed, it is important to maintain elevations to 30 degrees or lower to reduce tissue deformation. A reclined or slouched posture should be avoided, as this causes weight bearing and shear on the sacrum and coccyx. Flexing the knees and using repositioning cushions under the arms may prevent some sliding and slouching. When using the back-rest function on a bed it is also recommended that the client or caregiver use the trunk release manoeuvre which has been proven to reduce tissue interface pressures.
A knee break to further reduce shear
A knee break can be used as a tool to reduce the risk of shear forces exerted on the skin if a client were to slide down the bed. It can also be used to reduce the risk of heel pressure injuries.
Mattress compensation or auto-regression
This is a feature in which the head section not only moves up but also moves back to reduce shear forces exerted from the body being pushed forward in the bed.
Choose curved, flexible slats over “breathable” mattress bases
While many care beds claim to have breathable mattress bases, the best way to ensure good air circulation and postural support is to select a bed with curved slats. Curved slats provide a flexible base that adapts to different individuals and their sleeping profiles, while also supporting good pressure redistribution. Watch this short clip to see how these curved slats work.
Bed height adjustment range (travel range)
If the client requires caregiver assistance the height of the bed needs to be able to go high enough so they can safely provide repositioning and other support as required. Determining the optimal bed height for independent transfers is also a consideration. If a bed is too high for a client’s transfers, they may be at risk of dragging heels, legs, and sacrum into and out of the bed, especially if legs are heavy from conditions that cause poor circulation.
Reverse Trendelenburg and Trendelenburg
This feature enables the whole lying surface to tilt and can be used to redistribute pressure. It’s ideal for situations when a client needs or wants to be in a seated position in bed, however you do not want the head of bed elevation to be above 30 degrees. It’s also a good way to redistribute the pressure throughout the body and can be used in conjunction with sliding sheets to assist with repositioning the client by sliding them up or down the bed.
Choose the right support surface and positioning aids if needed
A bed with the best pressure care features is pointless is you don’t choose the right support surface (mattress) and in-bed positioning aids. There are several mattresses and positioning aids that will work with your bed to ensure the best outcome for your client whether they are low risk or high risk of pressure injuries. Like beds, there are so many different mattresses available today, that we recommend you seek help and advice from an equipment specialist who can guide you through the options.
Achieve a homely look with custom head and end boards
While a client may need the features of a medical bed, how it looks in their home can also be important. Rather than compromising on functionality, a client may wish to explore changing the look of a bed by adding a custom headboard or end board.
Lastly of course, consider long-term needs
While there are more home care style beds available today than ever before, many of them fail to provide the right clinical benefits and pressure care qualities required to support a client’s changing needs over time. Although it’s relatively easy to change or upgrade support surfaces over time, without the right platform, it won’t be as effective. It makes more sense to invest in a bed that’s designed to provide long-term pressure care support from the outset.
From a funding perspective, it’s also worth considering if the bed can be easily refurbished and re-issued.
For more about what to consider when choosing a bed with good pressure care qualities, watch this short video that Garry and Sharon created a few years ago (it’s an oldie but still useful).
Source: European Pressure Ulcer Advisory Panel, National Pressure Injury Advisory Panel and Pan Pacific Pressure Injury Alliance. Prevention and Treatment of Pressure Ulcers/Injuries: Clinical Practice Guideline. The International Guideline. Emily Haesler (Ed.). EPUAP/NPIAP/PPPIA: 2019.