Care bed

Nursing bed refers to a bed that is adapted to the special characteristics and needs of people in a phase of illness or with disabilities. The area of ​​application of care beds is in the home or inpatient care (old people's and nursing homes).

history

In the past, simply built wooden frames with a stable layer of boards and a straw mattress were often used in hospitals. If a patient required special positioning, an attempt was made to achieve the appropriate position with blankets or pillows. In the 19th century, rope-guided constructions were added, with which individual links (legs or arms) were specially stored.

The straw mattresses were replaced by other types of mattresses . Special beds for the sick have been developed in hospitals and military hospitals.

Manually adjustable systems were used for a long time. Electrically adjustable systems relieve the nursing staff and make the patient more autonomous. Technical innovations that have proven themselves in hospital beds are often also used in care beds.

Reasons for developing care beds

In the past, conventional beds placed particular emphasis on design and "comfort", whereby comfort was often understood to mean soft lying. Very often only simple and hard beds were available for the sick and disabled. With the knowledge that a needs-based person who has enjoyed a restful sleep,

• is both more resistant to an existing disease,
• as well as regenerated in a shorter time,

The first ideas for beds with extended functionality emerged.

With the introduction of an angle-adjustable back section, the reclining position could be kept reasonably stable in a semi-sitting position without additional pillows. This made eating in bed much easier to eat. Other forms of positioning became possible that were both pain-relieving and supportive of therapy.

The further division of the lying surface with the possibility of being able to adjust the individual parts at different angles led to new therapeutic forms of positioning. A great advantage of these fixed angles in the lying surface is that the patient cannot adjust the position through unconscious movements, as is the case with pillow positions.

With the development of the height-adjustable lying surface, consideration was also given to the work of the caregivers from an ergonomic point of view.

• The lying surface can be lowered to make it easier to get into the care bed.
• During care, the lying surface can be raised to "working height" (top edge of the mattress about 80 cm high).

The approved care beds now meet the following requirements:

• The materials used also meet very high standards of modern hygiene in the long term with a manageable cleaning effort
• The loads caused by both high body weight and a large number of movement cycles are withstood without failures.
• The beds are serviced regularly (as required by law).

In the years 1999 to 2002, in some cases of improper care in combination with a constructive weakness in the electrical system, short circuits occurred in care beds. As a result, there were repeated fires in the care beds. This weakness was remedied by increased requirements for the moisture protection of the electrical system. All approved care beds must at least meet the requirements of the standard for hospital beds ( EN 60601-2-52 ) in terms of safety . In addition to other requirements such as roll-over protection for the cables, the drive systems of care beds should have moisture protection class IPX 4.

The development of care beds has been driven more and more in two directions in recent years:

• Improvement of the equipment in many individual elements (improved handling of the control, environmental control / voice control, infrared remote control, more individually controllable segments of the slatted frame , etc.), development of design versions for the private market that distinguish them from a conventional bed does not recognize immediately.
  Here the health insurances see a transition from aids to alleviate a disability to an object of daily use. At the same time, not only classic medical supply stores, but also qualified specialist bed shops offer these care beds.
• Simplification of the equipment in order to meet the demands of the cash registers for cost reduction. Can be assembled and dismantled quickly to keep re-use costs low. Use of simple and robust materials.

Basic structure and functionality of care beds

Typical features of care beds are a reclining surface that can be adjusted several times, height adjustment to at least 65 cm and safely lockable castors with a minimum diameter of 10 cm. Materials and functional elements (motors, hand controls) must meet the special hygiene requirements in care.

The multiple divided, mostly electrically adjustable lying surface allows storage in different positions, such. B. the comfort seat, the shock or the heart position. The bed surface and mattress should be adapted to the body shape and weight as well as the clinical picture of the patient.

The height adjustability of the care bed enables both an ergonomic working height for caregivers and therapists as well as a suitable entry and exit position for residents.

Mattresses for care beds are not subject to any special regulations and are based on the habits of the user. In the case of specific clinical pictures, however, a special mattress may be necessary to avoid pressure points or to relieve the spine. For this purpose, anti-decubitus , pressure distribution or water mattresses can be used.

The following are available as accessories or special equipment:

• Raising aid with a triangle handle (bed hanger, colloquially "bed gallows")
• Angle adjustment of the entire lying surface for medical positioning (e.g. heart position)
• Side rails to prevent patients from falling out,
• as well as other fixation devices to secure restless patients.
• Infusion holder
• Footrests

Requirements for care beds

Nursing beds are subject to the regulations in their development, manufacture and sales

• of the Medical Devices Act (MPG) (legislation in Germany)
• the 93/42 EEC EC Medical Device Directive
• 89/336 EEC Electromagnetic Compatibility
• EN 1441 risk analysis medical devices (see risk management )
• EN 1970
• DIN EN 60601-1 medical electrical equipment
• DIN EN 60601-2-38 + A1
• DIN EN 60601-2-52 (intended to replace EN 1970 and DIN EN 60601-2-38)

Reimbursement of costs for care beds by the statutory health insurance companies (Germany)

If there is a corresponding indication (long bed-rest making care necessary, the need for special types of storage, etc.), the statutory health insurances must provide their members with a care bed . The care beds that may be used by the health insurances must be listed in the respective directories (list of medical aids or list of care aids) in accordance with the fifth book of the social security code (health insurance - SGB V) or the eleventh book of the social security code (long-term care insurance - SGB XI). The following number ranges are provided for care beds:

• (SGB V) 19.40.01.0001 to 19.40.01.3999 - In these number ranges, care beds with purely manual adjustment up to fully electric adjustment are listed.
• (SGB XI) 50.45.01.0001 to 50.45.01.2999 - In these number ranges, care beds with purely manual adjustment up to fully electric adjustment, as well as care beds for short people and children are listed.

In order to be listed in these resource lists, a product must go through a special approval process. The approval criteria include resilience, as well as longevity and structural and structural safety. Compliance with these criteria is checked by independent test institutes. Aids that are not listed require individual approval from both statutory and private health insurance.

Special care beds

Stand-up bed

In addition to the basic functions of a care bed, the stand-up bed also offers a swivel function that moves a person from the lying position into the sitting position, powered by an electric motor. Many activities such as eating, reading, etc. are easier to carry out in the sitting position (back and side rests). It also offers electromotive support when getting up. The area of ​​application of stand-up beds:

• Maintaining independence as well as re-training (e.g. after a stroke)
• Support of the circulatory system, breathing, as well as bowel and bladder activity in the case of long-term bed rest.
• Motor and functional support for active and passive mobilization.

Bed-in-bed systems / frame inserts

Bed-in-bed systems are one way of retrofitting the functionality of a care bed in a conventional bed frame. A bed-in-bed system offers a reclining surface that can be electrically adjusted several times and is inserted into an existing bed instead of the conventional slatted frame. The functionality of a care bed is thus integrated into the usual furniture of the bedroom.

Hospital bed

In hospitals, there are increased requirements for hygiene as well as the stability and longevity of a bed. In addition to the basic functions of a care bed, hospital beds are often also equipped with special devices (e.g. holders for infusions, connections for intensive care, etc.).

Low bed

With this further development of the classic care bed, the lying surface can be lowered close to the ground to prevent the effects of falls. The low bed height in the sleeping position of typically around 25 cm above the floor - possibly in conjunction with roll-off mats to be placed in front of the bed - reduces the risk of injury when falling out of bed. Low beds make it possible to largely dispense with classic but legally problematic so-called "freedom-restricting measures" (side rails, restraint devices), even for users with restless motor skills.

Side bed

The lying surface of a side bed can be rotated or angled in the longitudinal axis. This is usually done by lifting one long side of the lying surface. Alternatively, there are also variants in which the lying surface is divided into longitudinal segments. These longitudinal segments can then be angled as a group or individually.
The pressure load area of ​​the person lying in bed is shifted by changing the angle. Individual surfaces are relieved and the contact surface varied (surface pressure of the body increased or decreased).
These rearrangements can be time-controlled and carried out repeatedly. With this method, you can achieve decubitus protection similar to that of an alternating pressure mattress . A major difference to alternating pressure mattresses is the feeling of lying down. Lying on an alternating pressure mattress is often compared to lying on an air mattress. In the side bed, the patient usually lies on a foam mattress. When lying on the side there is the risk that the patient, if he does not control the side position himself, will be brought into an unplanned and possibly uncomfortable lying position.

Stand-up bed

In addition to the settings for lying and sitting positions, the lying patient can be brought into a standing position using the foot end. The standing bed is suitable for standing training for paraplegics and quadriplegics. It supports the circulation, breathing, as well as the bowel and bladder activity. For most patients, the actual standing function can only be controlled in a fixed position. Help towards independence is only possible to a very limited extent.

Intelligent care bed / smart bed

So-called “intelligent” or “smart” care beds are technically equipped care beds with sensor and reporting functions.
The sensors in the intelligent care bed can, for example, detect the presence of the bed, record the resident's movement profiles or register moisture in the bed. These measured values ​​are transmitted to the nursing staff by cable or wirelessly. They are coupled with alarm functions and serve the nursing staff to assess the need for action.
Intelligent care beds should contribute to improving the quality of care. For example, the documented sensor data on the intensity of movement in bed serve as a decision-making aid to identify whether a resident needs to be repositioned for pressure ulcer prophylaxis.

Ultra low bed / lowest bed / floor bed

Further development of the low bed with the possibility of lowering the lying surface to less than 10 cm above the floor, so that the prevention of the consequences of falls is guaranteed even without additional floor mats. In order to maintain and promote mobility, the particularly low altitude should also give people with limited mobility the opportunity to z. B. to get back to bed independently when standing on four feet.

Explanation of terms for colloquial use

Medical supply bed

Refers to a care bed for home care. Since care beds used to be sold almost exclusively through medical supply stores, this term has become common in some areas.

Senior bed

This is often used to refer to a care bed. In the specialist bed trade, however, a normal bed with an increased lying surface (mattress top edge height> 50 cm) is called this. The aim of this higher lying surface is that the feet are in the sitting position above the floor, so that one can slide off the edge of the bed.

Individual evidence

1. ^ Medical Association of North Rhine-Westphalia: Safety risks of sick and care beds according to a medical product information from the Ministry for Women, Youth, Family and Health of the State of North Rhine-Westphalia from May 23, 2001. Retrieved on April 10, 2009
2. ^ Nursing beds: structure and equipment , accessed on August 16, 2014
3. ↑ Ilka Köther, Karin Baum, Regina Bracht, Viorel Constantinescu: "THIEMEs Altenpflege". Thieme-Verlag, 2007
4. ^ Judgment of the III. Civil Senate of July 14, 2005 - III ZR 391/04 -. In: juris.bundesgerichtshof.de. Retrieved June 3, 2016 . 
5. ↑ Anna Barker, Jeannette Kamar, Tamara Tyndall, Keith Hill: Reducing serious fall-related injuries in acute hospitals: are low-low beds a critical success factor? In: Journal of Advanced Nursing . tape 69 , no. 1 , January 1, 2013, ISSN  1365-2648 , p. 112–121 , doi : 10.1111 / j.1365-2648.2012.05997.x ( wiley.com [accessed June 3, 2016]).
6. ^ Hao Cai et al .: Health Professionals 'User Experience of the Intelligent Bed in Patients' Homes . In: International Journal of Technology Assessment in Health Care . tape 31 , no. 4 , January 1, 2015, ISSN  1471-6348 , p. 256-263 , doi : 10.1017 / S0266462315000380 .
7. ^ S. Ajami, L. Khaleghi: A review on equipped hospital beds with wireless sensor networks for reducing bedsores. In: International Journal of Research in Medical Sciences . tape 20 , no. 10 , October 1, 2015, ISSN  2320-6012 , p. 1007-1015 , doi : 10.4103 / 1735-1995.172797 .
8. ↑ Andreas Büscher et al .: Expert standard according to § 113a SGB XI Maintaining and promoting mobility in care. German Network for Quality Development in Nursing (DNQP), June 13, 2014, accessed on June 3, 2016 .