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Patient safety alert issued in the UK over risk of death relating to medical beds

A national patient safety alert has been issued in the UK over the risk of death from entrapment or falls relating to medical beds, with a call for all relevant staff to have appropriate training within the next 12 months.

In an alert issued on Wednesday 30 August, the Medicines and Healthcare products Regulatory Agency (MHRA) said it continues to receive reports of death and serious injuries relating to medical beds and trolleys.

Between 1 January 2018 and 31 December 2022, the MHRA received 18 reports of death and 54 reports of serious injuries related to medical beds, bed rails, trolleys, bariatric beds, lateral turning devices and bed grab handles.

The MHRA confirmed to Nursing in Practice that these incidents included medical beds used outside of a hospital setting.

And it said the ‘majority’ of the reported incidents were because of entrapment or falls.

Investigations into incidents that involved falls ‘often found the likely cause to be worn or broken parts, which should have been replaced during regular maintenance and servicing, but which were either not carried out or were carried out improperly’, the MHRA said in its alert.

Meanwhile, those incidents involving entrapment were due to factors including: a lack of risk assessment or risk assessments not being updated following a change in equipment or patient’s condition, a lack of maintenance and servicing, incompatibility issues and children and adults with ‘atypical anatomy using inappropriate equipment’.

As part of its patient safety alert, the MHRA outlined several actions to be taken by all those responsible for the use, purchase, prescription and maintenance of medical beds, including acute and community organisations, care homes, equipment providers, occupational therapists and early intervention teams, to begin and complete by March 2024.

One action called for role-specific training for staff that covered, where appropriate, the ‘risks and operation of these devices, the provision of training to carers/patients, reporting issues, servicing and maintenance and risk assessments’.

And it said that organisations should develop a plan for all staff to be appropriately trained within the next 12 months.

Other actions asked providers to review their medical device management systems, to implement maintenance and servicing schedules and to implement systems to update risk assessments.

Organisations were also urged to update their polices and procedures on procurement, provision, prescribing, servicing and maintenance of such devices in line with updated MHRA guidance.

In addition, it called for patients currently provided with bed rails or bed grab handles to be reviewed ‘to ensure there is a documented up-to-date risk assessment’.

Patients who are children or adults with atypical anatomy should be reviewed ‘as a priority’, it noted.

A version of this story was originally published by our sister publication Nursing in Practice.