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What Are Enclosed Beds?
Enclosed, Full Enclosure, Canopy are all terms that are commonly used to describe a safety bed that has a full 360 degree barrier around the perimeter of the mattress for fall protection or to prevent the patient from exiting the bed without assistance. Most generally, but not always, there is a top or "canopy" as well. These beds can be made for children, youth or adults. The barriers can be made from a variety of materials.
What’s Wrong with Enclosed Bed Systems?
All of the following statements
were made by
NYS Department of Health
Office of Medicaid Management
Bureau of Program Guidance
99 Washington Ave., Suite 720
Albany, NY 12210
“Medicaid does not approve, cover, pay for or otherwise
sanction the use of enclosed bed systems designed to prevent children
and some adults with disabilities from getting out of bed.”
“Enclosed beds constitute a restraint and may pose even greater risks of harm than those posed by other, less restrictive interventions, such as increased monitoring, alarm systems, padding or placing the mattress on the floor. “
“The Commission on Quality of Care for the Mentally Disabled has concluded that there is no medical justification for enclosed bed systems. The real need is to proactively address the underlying medical and/or behavioral issues that give rise to the risk of harm. Restraints should be used on an emergency, time-limited basis only when an imminent risk of harm arises, and only the least restrictive form of restraint should be employed. The literature accompanying enclosed beds seems to promote their long-term use and makes no mention of improving the underlying problems that suggest the need for this level of intervention. “
“The Division of Quality Assurance of the Office of Mental Retardation and Developmental Disabilities has prohibited the use of these beds in all OMRDD-funded, operated or certified facilities.”
What is Entrapment?
from FDA
Report
"The term "entrapment" describes an event in which a patient/resident
is caught, trapped, or entangled in the space in or about the bed rail,
mattress, or hospital bed frame. Patient entrapments may result in
deaths and serious injuries. "
Why Does Entrapment Matter?
from FDA Report
"(The) FDA received approximately 691 entrapment reports over a period
of 21 years from January 1, 1985, to January 1, 2006. In these reports,
413 people died, 120 were injured, and 158 were near-miss events with
no serious injury as a result of intervention. These entrapment events
have occurred in openings within the bed rails, between the bed rails
and mattresses, under bed rails, between split rails, and between the
bed rails and head or foot boards. The population most vulnerable to
entrapment are elderly patients and residents, especially those who are
frail, confused, restless, or who have uncontrolled body movement.
Entrapments have occurred in a variety of patient care settings,
including hospitals, nursing homes, and private homes. Long-term care
facilities reported the majority of the entrapments. "
Is Entrapment a Real Concern?
Based on studies done by the FDA if a patient is trapped or entangled
in one or more of the 7 Zones as outlined in their treatise, 77% of the
time the person will be injured and 59% of the time the patient will
die.
Why Can’t I just buy a $30 side rail from a retail store?
Accidental
asphyxia in bed in severely disabled children
Authors: Amanuel, B1;
Byard, RW
Source: Journal
of Paediatrics and Child Health,
Volume 36, Number 1, February 2000 , pp. 66-68(3)
Publisher: Blackwell Publishing
Objective: To determine whether there are specific situations which may
increase the risk of accidental asphyxia during sleep in children with
physical and mental disabilities.
Of those cases (studied), two involved children with significant mental
and physical impairment.
Case 1: A 4-year-old boy with Klippel-Trenaunay-Weber syndrome, macrocephaly and severe developmental delay, was found dead with his head hanging over a wooden board attached to the side of his bed.
Case 2: A 4-year-old boy with lissencephaly and severe developmental delay was found dead wedged between a retractable mesh cot side and the side of his bed.
In both cases the devices resulting in death had been put in place to prevent the boys from falling out of bed.
Inclusion
http://specialed.about.com/cs/integration/a/inclusion.htm
http://www.newhorizons.org/spneeds/inclusion/front_inclusion.htm
http://www.newhorizons.org/spneeds/inclusion/information/schwartz3.htm
