Sunday, 7 February 2010

MAKING AN OCCUPIED BED

For the bedridden patient, daily linen changes promote comfort and help prevent skin breakdown and nosocomial infection. Such changes necessitate the use of side rails to prevent the patient from rolling out of bed and, depending on the patient's condition, the use of a turning sheet to move him from side to side.
Making an occupied bed may require more than one person. It also entails loosening the bottom sheet on one side and fanfolding it to the center of the mattress instead of loosening the bottom sheet on both sides and removing it, as in an unoccupied bed. Also, the foundation of the bed must be made before the top sheet is applied instead of both the foundation and top being made on one side before being completed on the other side. (See Making a traction bed, page 72.)
Equipment
Two sheets (one fitted, if available) • pillowcase • one or two drawsheets • spread • one or two bath blankets • gloves • sheepskin or other comfort-enhancing device, as needed • optional: laundry bag, linen-saver pad.
Preparation of equipment
Obtain clean linen and make sure it's folded properly, as for an unoccupied bed.
Implementation
  • Wash your hands, put on gloves, and bring clean linen to the patient's room.
  • Identify the patient and tell him you'll be changing his bed linens. Explain how he can help if he's able, adjusting the plan according to his abilities and needs. Provide privacy.
  • Move any furniture away from the bed to ensure ample working space.
  • Raise the side rail on the far side of the bed to prevent falls. Adjust the bed to a comfortable working height to prevent back strain.
  • If allowed, lower the head of the bed to ensure tight-fitting, wrinkle-free linens.
  • When stripping the bed, watch for belongings among the linens.
  • Cover the patient with a bath blanket to avoid exposure and provide warmth and privacy. Then fanfold the top sheet and spread from beneath the bath blanket, and bring them back over the blanket. Loosen the top linens at the foot of the bed and remove them separately. If reusing the top linens, fold each piece and hang it over the back of the chair. Otherwise, place it in the laundry bag. To avoid dispersing microorganisms,
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    don't fan the linens, hold them against your clothing, or place them on the floor.
  • If the mattress slides down when the head of the bed is raised, pull it up again. Adjusting the mattress after the bed is made loosens the linens. If the patient is able, ask him to grasp the head of the bed and pull with you; otherwise, ask a coworker to help you.
  • Roll the patient to the far side of the bed, and turn the pillow lengthwise under his head to support his neck. Ask him to help (if he can) by grasping the far side rail as he turns so that he's positioned at the far side of the bed.
  • Loosen the soiled bottom linens on the side of the bed nearest you. Then roll the linens toward the patient's back in the middle of the bed.
  • Place a clean bottom sheet on the bed, with its center fold in the middle of the mattress. For a fitted sheet, secure the top and bottom corners over the side of the mattress nearest you. For a flat sheet, place its end even with the foot of the mattress. Miter the top corner as you would for an unoccupied bed to keep linens firmly tucked under the mattress, preventing wrinkling.
  • Fanfold the remaining clean bottom sheet toward the patient, and place the drawsheet, if needed, about 15″ (38 cm) from the top of the bed, with its center fold in the middle of the mattress. Tuck in the entire edge of the drawsheet on the side nearest you. Fanfold the remaining drawsheet toward the patient.
  • If necessary, position a linen-saver pad on the drawsheet to absorb excretions or surgical drainage, and fanfold it toward the patient.
  • Raise the other side rail, and roll the patient to the clean side of the bed.
  • Move to the unfinished side of the bed, and lower the side rail nearest you. Then loosen and remove the soiled bottom linens separately and place them in the laundry bag.
  • Pull the clean bottom sheet taut. Secure the fitted sheet or place the end of a flat sheet even with the foot of the bed, and miter the top corner. Pull the drawsheet taut and tuck it in. Unfold and smooth the linen-saver pad, if used.
  • Assist the patient to the supine position if his condition permits.
  • Remove the soiled pillowcase, and place it in the laundry bag. Then slip the pillow into a clean pillowcase, tucking its corners well into the case to ensure a smooth fit. Place the pillow beneath the patient's head, with its seam toward the top of the bed to prevent it from rubbing against the patient's neck, causing irritation. Place the pillow's open edge away from the door to give the bed a finished appearance.
  • Unfold the clean top sheet over the patient with the rough side of the hem facing away from the bed to avoid irritating the patient's skin. Allow enough sheet to form a cuff over the spread.
  • Remove the bath blanket from beneath the sheet, and center the spread over the top sheet.
  • Make a 3″ (7.6-cm) toe pleat, or vertical tuck, in the top linens to allow room for the patient's feet and prevent pressure that can cause discomfort, skin breakdown, and footdrop.
  • Tuck the top sheet and spread under the foot of the bed, and miter the bottom corners. Fold the top sheet over the spread to give the bed a finished appearance.
  • Raise the head of the bed to a comfortable position, make sure both side rails are raised, and then lower the bed and lock its wheels to ensure the patient's safety. Assess the patient's body alignment and his mental and emotional status.
  • Place the call button within the patient's easy reach. Remove the laundry bag from the room.
  • Remove and discard gloves and wash your hands to prevent the spread of nosocomial infections.

Special considerations
  • Use a fitted sheet, when available, because a flat sheet slips out from under the mattress easily, especially if the mattress is plastic-coated.
  • Prevent the patient from sliding down in bed by tucking a tightly rolled pillow under the top linens at the foot of the bed.
  • For the diaphoretic or bedridden patient, fold a bath blanket in half lengthwise and place it between the bottom sheet and the plastic mattress cover; the blanket acts as a cushion and helps absorb moisture. To help prevent sheet burns on the heels and bony prominences, center a bath blanket or sheepskin over the bottom sheet, and tuck the blanket under the mattress.
  • If the patient can't help you move or turn him, devise a turning sheet to facilitate bed making and repositioning. To do this, first fold a drawsheet or bath blanket and place it under the patient's buttocks. Make sure the sheet extends from the shoulders to the knees so that it supports most of the patient's weight. Roll the sides of the sheet to form handles. Next, ask a coworker to help you lift and move the patient. With one person holding each side of the sheet, you can move the patient without wrinkling the bottom linens. If you can't get help and must turn the patient yourself, stand at the side of the bed. Turn the patient toward the rail, and, if he's able, ask him to grasp the opposite rolled edge of the turning sheet. Pull the rolled edge carefully toward you and turn the patient.
Documentation
Although linen changes aren't usually documented, record their dates and times in your notes for patients with incontinence,
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excessive wound drainage, pressure ulcers, or diaphoresis.