Taking Care in Bed
When caring for someone in bed it is important to keep them comfortable and to maintain skin health, good posture, movement, eating, drinking and continence in bed. Here are some ideas to keep the person safe and comfortable and protect the carers too.
Keeping skin healthy in bed
The pressure ulcer risk increases when the person’s weight is not supported evenly in the bed and if the person cannot change their position in bed. When sitting up in bed, with pillows or a backrest, the person will slide down the bed causing a high risk of pressure damage on buttocks, and bony parts like heels, elbows and the back of the head.
A Pillow under the knees can give some support to stop the slide when sitting up in bed. A pillow each side of the body can also help to support arms and elbows.
A powered profiling bed can be adjusted to support the person when lying flat or sitting up in bed. Always raise the knee section of the bed before raising the head section of the bed, to stop the person sliding down the bed and to reduce the pressure on bony parts. The profiling bed hand controls can also be used to change position frequently to relieve pressure.
If the person sleeps on their side be aware of pressure risk to their elbows and between knees and ankles; relieve pressure with careful positioning and off load pressure with soft supports.
If there is a risk of skin damage, contact the local community nurse team for advice.
Changing position in bed relieves pressure to keep skin healthy; the right equipment can help.
A bed that is the right height will help when getting in and out of bed; it should be low enough to sit on the bed with feet on the floor and to get legs up into bed, but high enough to stand up from the bed and for carer assistance when in bed. Bed raising blocks can be added onto bed legs or castors to increase the height.
Satin slide sheets are used in bed in place of standard sheets, to make it easier to get in and out of bed and to change position in bed to relieve pressure.
Bed grab handles are fitted under the mattress or onto the bed frame to give a firm grip to get in and out of bed and move in bed. Grab handles must be positioned to avoid entrapment risk.
A bed ladder fits securely to the end of the bed and the rungs can be used to pull up into a sitting position in bed.
A Powered pillow lift, leg lifter or mattress variator can be fitted to the bed at home to help when moving and getting in and out of bed.
A height adjustable powered profiling bed may be needed to support care in bed so that it can be adjusted to the right height for carers to assist the person in bed.
If the person lies for a long time with knees bent and legs swept over to one side, it is important to get support and positioning advice from a Physiotherapist or Occupational therapist to reduce the risk of body shape changes.
See ‘Taking Care of Posture’ guidance.
Eating, drinking in bed
Eating and drinking in bed is safer when sitting up as this helps safe swallowing.
A bed backrest or V pillow can support a good upright position for a short time while eating and drinking BUT will increase the risk of pressure damage on bottom and heels. Add a pillow under the knees to relieve pressure when sitting up in bed and a pillow each side can also give support when eating and drinking in bed.
A tray or over bed table should be positioned as close as possible to maintain that upright position for safe swallow. Some profiling beds can be adjusted into a chair like position when eating and drinking in bed. See ‘Taking Care when Eating and Drinking’ guidance
Managing Continence in bed
Managing continence in bed may be easier with a bedside commode or by using a urinal bottle. Urinals for men and women are available with a collection bag, which reduces the risk of spilling. Urinals are most effective when sitting up or sitting on the side of the bed with feet on the floor. Some urinals are designed for use when lying down. Absorbent, close fitting pads may be needed at night to prevent leaks. Absorbent bed sheets can be used to reduce the carers work load at night and for a better night sleep. Be aware of the risk of skin damage when wearing wet pads and when lying on damp surfaces. See ‘Taking Care when Managing Continence’ guidance
Preventing Falls from the bed
Falling out of bed may be avoided by lying in the middle, away from the edge of the bed.
Pillows placed under the sheet, each side of the person’s shoulders or legs may be enough to stop them sliding off the bed.
Padded bed wedges that fix with Velcro, can also be used to prevent slipping out of bed.
A low bed may reduce injury if the person falls out of bed frequently, but a low bed will make standing up from bed more difficult.
A crash mat on the floor can reduce injury when falling from the bed, but the carer will need to consider how to get the person back up from the floor safely.
A pendant alarm can be used to call for help when getting out of bed.
A bed sensor alarm or floor mat alarm can be set up to alert a carer if the person is unable to call for assistance when getting out of bed or when they have fallen from bed.
Bed Safety Rails can prevent falls from bed, but are risky if the person might climb over or if the person needs to get out of bed independently during the night.