Implementation of CommunityBed with JuniorKit in Nottinghamshire

Introduction

In 2019 after Sarah, ICELS Partnership Manager, and her team had been experiencing a range of challenges with children’s bed provision for children of a certain size - more than 75 cm tall and less than 146 cm. A children’s bed working group was set up to discuss children’s bed provision.

At that time, it was felt there were two main options; accommodate a child in an adult bed with a range of additional accessories or purchase a bed made specifically for children. Both had their limitations and impacted on safety, effectiveness, cost and efficiency.

It was also around this time that the new manufacturing standard BS EN 50637:2017 about medical beds for use with children came out. This was a standard that came into force in August 2020 and required manufacturers to manufacture beds with reduced gaping measurements to prevent entrapment of smaller limbs and increased testing to ensure compliance. Sarah and the team began to explore the market in detail to determine if there was a suitable option that could be added to the catalogue as a standard stock product that would meet most of the children’s needs in a safe, efficient and cost-effective way.

Challenge

Sarah explained that when a need for a profiling bed for a child or small adult of a certain size had been identified, the prescriber explored the suitability of provision of an adult bed that was a standard stock item; in some cases the needs were met with a standard adult bed which may have required some accessories. However Sarah explained it often required significant risk assessment and exploration to determine if the adult bed was suitable and what accessories were safe to use.

One of the biggest concerns was the size of the gaps, especially between the bed frame and side rails and the side rails and mattress. The gaps were often larger than safe for a child of a certain size, increasing the risk of entrapment and so additional adjustments or alternative solutions were required.

When the risk of entrapment in an adult bed was identified it was necessary to explore a profiling bed that had been specifically designed for children. There is quite a substantial range of paediatric profiling beds on the market, usually with many more features and options than an adult bed and although these beds often met the needs due to appropriate gaps reducing the risk of entrapment, many of these additional features and functions were often not required. Due to the complexity and variety of options these beds tend to be much more expensive and an over prescription for many of the service users. In addition, the side rail clearance height was not always adequate and increased the risk to some service users and resulted in newly purchased beds having to be collected and stored in the warehouse and alternative beds being purchased.

Sarah commented that this process of prescribing an appropriate bed for a child was often very time consuming for the prescriber and if a new special bed was required the delivery time was also significant. In the meantime the child’s needs were not being adequately met in some cases for up to 5 months. 

Another concern that had been highlighted was that a vast range of beds were being prescribed and this made the cleaning, repairing and reissuing of the beds more challenging as prescribers and technicians were not familiar with many of the beds and found it hard to become familiar as there were so many varieties. This occasionally resulted in beds not being reissued, taking up valuable space in the warehouse.

Solution

Sarah and the children’s bed working group agreed that with the new standards coming into force it was a perfect opportunity to explore suitable beds for children that could be considered for standard stock. They therefore contacted a variety of manufacturers to identify which profiling beds would meet the standards and could be considered for standard stock. Sarah advised that some manufacturers of adult profiling beds reported they were not intending to manufacture a bed that would meet the standards and the main reason for this was their concern regarding the positions of the profiling mechanisms – the back rest and knee break. Sarah highlighted that the location of the knee break was not a concern for her and the team as a wedge under the knees can be used instead of the knee break function and can be adjusted accordingly as the child grows.

Several companies who had a suitable profiling bed that met the children’s standards were invited to bring their bed and demonstrate the features and functions to a large range of clinicians and prescribers working with children from both the Health and Social Care teams. 

Accora was one of these companies and Sarah reported that there was an overwhelming preference from the prescribers for the Accora CommunityBed with the JuniorKit. Accora demonstrated how they had met the standards by using a JuniorKit which consists of a mesh sleeve to go over the mattress platform of the CommunityBed which then zipped up to head and footboard bumpers. To accommodate a wide range of needs and increase safety, Accora also presented their mesh side rails and a firm edge mattress that could be added or removed from the bed at any time. The purpose of the firm edge mattress was to reduce the risk of entrapment between the side rails and mattress which can often occur when a mattress is compressed. The firm edge of the mattress prevents compression to a large extent, therefore reducing the risk of entrapment.

Following further discussion, Accora provided all the information including pricing and the codes required to enable them to add the JuniorKit and CommunityBed to the catalogue. The JuniorBed was readily available once the information had been provided and regular training to help prescribers familiarise themselves with the bed was provided.

Sarah advised of the following Key benefits of adding the Accora JuniorBed to the standard stock catalogue:

• Accora have combined the JuniorKit with their CommunityBed to create a profiling bed that meets the new children’s standards for children more than 75 cm tall and less than 146 cm.
• If a child requires the benefits of the ultra-low function of a FloorBed, the JuniorKit can be used on this bed as well.
• The CommunityBed is also standard stock for adults. This means the bed can be used effectively for adults or anyone taller than 146 cm with or without the JuniorKit. 
• This is a cost-effective way of meeting many children’s needs that would be at risk in a standard adult bed. 
•  Having this option on stock as standard results in much quicker bed provision to children in this category. 
• There is more consistency throughout the service. 
• The cleaning, technical management, delivery, and installation of the beds is much more efficient due to those working with the beds being more familiar with them.
• There is a more consistent and better provision and accessibility for prescribers, service users and the equipment service. 
• Monitoring stock levels is much easier and as a result it is usually possible to get a JuniorBed out within a week.

Conclusion

Sarah reported that the implementation went very well, advising that in addition to the benefits and cost savings, the whole service provided by Accora has been very positive and made the process simple and easy for all those involved. Sarah advised that their service worked in partnership with Accora very well and they formed a nice team dynamic to enable the smooth implementation and the prescription of the CommunityBed with the JuniorKit. 

Sarah highlighted that Accora provides the right level of support required to enable the prescribers to be familiar with the bed and enable them to meet the needs of approximately 95% of the service users being referred. The support includes:

• Joint working with Accora to go through guidance on provision to ensure that prescribers know what they need to order when meeting specific needs. 
• Initially due to Covid all training was carried out online and then face-to-face training was provided as and when required to provide ample opportunity to all prescribers to become familiar with the CommunityBed and JuniorKit.
• Availability of a Product Specialist to carry out joint visits with prescribers when required.
• Training is available to technicians, prescribers, and the commissioning team as required.
• A technical advisor is available and provides support and regular training to technicians and drivers to ensure they are familiar and confident with the use of the CommunityBeds and JuniorKits.
• Accora’s Consultant Occupational Therapists and Tissue Viability Nurse are also readily available to provide training from a clinical perspective and provide advice on appropriate provision for specific users as required.

Sarah advised that she has had anecdotal feedback on the implementation of the JuniorBed which has been really positive and further follow up reviews are being carried out to gather more feedback from the service users, their carers and families as well as the prescribers who have been ordering them.

In addition, the quick access has reduced delays of hospital discharge and safety issues. 

Sarah also advised that they have made the decision that when using side rails on the bed, the prescribers have to order the foam or hybrid mattress with firm edges to reduce the risk of entrapment. 

Cost savings

Sarah advised that on an initial analysis for the first year, there is an indication that 60 bed packages have been issued and this has provided a potential cost saving against a specialist bed which has an average cost of £6,000. This totals a saving in the region of £260,000.

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