What bed size does a patient need?

What bed size does a patient need?

In 2014/15, more than one in four adult Australians were obese. This represents almost five million Australians aged 18 and over (BMI of 30.0kg/m2 or more). Compared to 1995, the proportion of Australians that are obese in 2015 has increased by 49%.1 As the general population has increased in body size, so too has the hospital population. From 2006 to 2015, the mean patient weight in acute care increased from 80.5 to 83.7 kg.2 Over the same period, the mean BMI increased from 29.0 to 29.7 kg/m2, which is very near the definition of obese. A particular challenge for caregivers is that, although the mean body weight of the population is increasing, the heaviest patients are increasing at an even faster rate.

To properly care for a patient of size, caregivers require specialised equipment that can accommodate the dimensions, weight, and specific mobility needs of such patients.3 Matching the patient with the proper size of hospital bed is particularly important for the recovery of the patient and the safety and effectiveness of the care team. The hospital bed is typically the piece of equipment with which the patient has the most contact and is central to most aspects of nursing care. The standard width of a hospital bed is 91 cm, although 102 cm and 127 cm widths are also available. Currently, there is no data to support guidance on what size of bed should be selected for a particular patient.

Background

There is little mention in the literature of how to select aÊbed size for a patient, and none of these recommendations appear to be supported by empirical evidence on patient space requirements. In many cases, the lowest weight capacity of standard equipment appears to drive bariatric protocols, such as using a wider bed for patients weighing greater than 159 kg.4 Another source suggests assigning specialised "bariatric" beds for patients heavier than 147 kg or with a BMI greater than 55 kg/m2, although it is unclear how this threshold was determined.5

Caregivers can experience negative consequences when there is insufficient space to turn a patient in bed who is unable to self-reposition.

Of the many activities performed by patients and caregivers using the hospital bed, moving from supine to side lying is an activity that requires a particularly large amount of space to accommodate the patient. Patients who have insufficient space to turn in bed may have limited ability to reposition the body, which could increase discomfort or negatively impact patient sleep. Many patients, particularly those who have undergone abdominal surgery, must first turn to their side and then push up or rotate about the hips to stand.6  Without space to turn, those patients must flex at the hip, contracting abdominal muscles, which could cause additional pain.7

In addition to potentially affecting comfort and patient satisfaction, insufficient space to turn in bed may negatively impact patient outcomes. Caregivers must frequently turn patients for a variety of objectives that include wound inspection, dressing changes, repositioning to relieve pain, bed pan placement, linen changes, cleaning or bathing, helping to mobilise patients, or for repositioning to prevent pressure injuries.8 If a patient is unable to self-reposition or be easily turned by caregivers, that patient may not as frequently off-load parts of the body exposed to sustained pressure that can lead to pressure injuries.10,11 Fragala, Perry, and Fragala (2012)9 have also suggested that in long-term care, a bed that is too narrow may increase the likelihood that patients could roll past the edge of the bed and fall.

Caregivers can experience negative consequences when there is insufficient space to turn a patient in bed who is unable to self-reposition. If a bed is only slightly wider than the space required to turn the patient, caregivers must first laterally reposition the patient to the edge of the bed that is opposite the direction of the turn before turning the patient. Without this lateral repositioning the patient would otherwise roll off the bed or be turned into the opposite side rail resulting in impingement. This lateral repositioning requires high pull forces and exposes caregivers to a greater risk of injury than turning the patient.12 If there is insufficient space for the patient to be turned even once, then caregivers must turn and laterally slide the patient simultaneously, which is physically demanding and requires additional staff.

Although there are many consequences to having a bed that is too narrow, there may also be drawbacks to using beds that are unnecessarily wide. Wider beds tend to cost more, and using a bed that is needlessly wide may incur unnecessary costs for the healthcare institution. Moreover, an unnecessarily wide bed will require caregivers to reach farther as they extend their arms from the edge of the bed to the patient, which could increase the risk of back injury.13

Patients who are unable to self-reposition with a BMI up to 35 kg/m2could be placed on a 91-cm wide bed, patients up to 40 kg/m2 could be placed on a 102-cm wide bed, and patients with a BMI greater than 40 kg/m2 should be on a 127cm wide bariatric bed. For patients with the ability to self-reposition, those with BMI up to 45 kg/m2 could be placed on a 91 cm wide bed, up to 55 kg/m2 could be placed on a 102 cm wide bed, and those with BMI greater than 55 kg/m2 should be placed on a bariatric bed. These minimum requirements are summarized in the table below.

Hospital administrators can use historical demographic information about the BMI of their patient populations to plan facility-level equipment procurement for equipment that accommodates their patients.

 

References


  1. Australian Bureau of Statistics. Australian Health Survey 2014/15 [4364.0]

  2. VanGilder C., Lachenbruch C., Algrim-Boyle C., & Meyer S. (2017). The International Pressure Ulcer Prevalenceª Survey: 2006Ð2015: A 10-year pressure injury prevalence and demographic trend analysis by care setting.ÊJournal of Wound Ostomy & Continence Nursing, 44, 20Ð28. doi:10.1097/WON.0000000000000292

  3. Camden S. G. (2006). Nursing care of the bariatric patient.ÊBariatric Nursing and SurgicalÊPatient Care, 1(1), 21Ð30. doi:10.1089/bar.2006.1.21

  4. Muir M., & Archer-Heese G. (2009). Essentials of a bariatricÊpatient handlingÊprogram.ÊOJIN: The Online Journal of Issues in Nursing, 14(1), Manuscript 5. doi:10.3912/OJIN.Vol14No1Man05

  5. Gourash W., Rogula T., & Schauer P. R. (2007). EssentialÊbariatric equipment: Making your facility more accommodating to bariatric surgical patients. In Schauer P. R., Schirmer B. D., Brethauer S. (Eds.),ÊMinimally invasive bariatric surgeryÊ(pp. 37Ð49). New York, NY: Springer.

  6. Zafiropoulos B., Alison J. A., & McCarren B. (2004). Physiological responses to the early mobilisation of the intubated, ventilated abdominal surgery patient.ÊAustralian Journal of Physiotherapy, 50, 95Ð100. doi:10.1016/S0004-9514(14)60101-X

  7. Smith-Temple J., & Johnson J. Y. (2006).ÊNurses' guide to clinical proceduresÊ(5th ed.). Philadelphia, PA: Lippincott Williams & Wilkins.

  8. Smith S. F., Duell D. J., Martin B. C., Gonzalez L., & Aebersold M. (2017).ÊExercise and ambulation. Clinical nursing skills: Basic to advanced skillsÊ(9th ed.). New York, NY: Pearson.

  9. Fragala G., Perry B., & Fragala M. (2012). ExaminingÊbedÊwidth as a contributor to risk of falls fromÊbedÊin long-term care.ÊAnnals of Long-Term Care: Clinical Care and Aging, 20(6), 35Ð38.

  10. Brindle C. T., Malhotra R., O'Rourke S., Currie L., Chadwik D., Falls P., É Creehan S. (2013). Turning and repositioning the critically ill patient with hemodynamic instability: A literature review and consensus recommendations.ÊJournal of Wound Ostomy & Continence Nursing, 40, 254Ð267. doi:10.1097/WON.0b013e318290448f

  11. Oertwich P. A., Kindschuh A. M., & Bergstrom N. (1995). The effects of small shifts in body weight on blood flow and interface pressure.ÊResearch in Nursing & Health, 18, 481Ð488.

  12. Wiggermann N. (2016). Biomechanical evaluation of aÊbedÊfeature to assist in turning and laterally repositioning patients.ÊHuman Factors, 58, 748Ð757. doi:10.1177/0018720815612625

  13. Waters T. R. (2007). When is it safe to manually lift a patient?ÊAmerican Journal of Nursing, 107, 53Ð58.




    14.  
  14.  
  15.  

To properly care for a patient of size, caregivers require specialised equipment that can accommodate the dimensions, weight, and specific mobility needs of such patients.Matching the patient with the proper size of hospital bed is particularly important for the recovery of the patient and the safety and effectiveness of the care team. As the general population has increased in body size, so too has the hospital population. From 2006 to 2015, the mean patient weight in acute care increased from 80.5 to 83.7 kg.2 Over the same period, the mean BMI increased from 29.0 to 29.7 kg/m2, which is very near the definition of obese.