How to Conduct a Bed Area Safety Check

Bed safety checks in ICU and high acuity clinical areas may seem like an easy and basic task. However, they are a crucial responsibility, which, if performed incorrectly, may impact patient survival in an emergency situation.

With the COVID-19 pandemic leading to an increase of critically unwell patients being admitted to hospitals, it is important to be adequately prepared for any adverse events. This means ensuring equipment is working and ready, and the patient’s space is safe.

What is a Bed Safety Check?

A bed safety check is the first task you should undertake after handover at the commencement of your shift. It involves:

• Ensuring all equipment is available and working in the event of patient deterioration or another adverse event.
• Ensuring the patient’s bed space is tidy, safe and free from potential harm to the patient, clinician or visitors.

(ARC & NZRC 2014; CICM 2011)

How to Perform a Bed Safety Check

1. Perform hand hygiene and don appropriate PPE (if necessary) before entering the patient area.
2. Introduce yourself to the patient and explain what you are doing.
3. Check the patient’s identification band.
4. Check oxygen and suction.
5. Clinicians must be familiar with the location of all resuscitation equipment within their clinical area including air viva.
6. Wall oxygen and suction must be checked, with appropriate tubing connected. Air viva should be connected to oxygen, ready for use in an emergency. Yanker sucker should be connected to the suction outlet.
7. Portable oxygen and suctioning should also be located and checked in case the wall supply is not working.
8. Blood pressure cuff, pulse oximetry and 5-lead cardiac monitoring should be in situ on the patient for continuous and regular observations (in high acuity clinical areas).
9. Locate the emergency trolley and automated external defibrillators (AED). Early CPR and defibrillation decrease mortality rates.
10. Check all intravenous lines and arterial catheter lines are attached to infusion pumps and ensure the right medicine is in the correct fluid bag (check this with two Division One nurses at handover).
11. Ensure all drain tubes and indwelling catheters are free from occlusion.
12. Check mechanical ventilation or non-invasive ventilation devices (if applicable), ensuring all settings are correct as per the patient’s treatment plan.
13. Remove any furniture or equipment that is no longer needed out of the bed space.

(ARC & NZRC 2014; Butcher & Cooper 2020; The Royal Hospital for Women 2016)

Note: There may be a nurse allocated to conduct an additional equipment check. A system should be established to ensure that equipment is replaced when necessary and checked for safety (CICM 2011).

Possible Bed Safety Issues

• Air viva may not be available in an emergency situation. This can be detrimental - call for help and start CPR.
• If there is no yanker sucker available to remove secretion from the patient’s mouth, call for assistance.
• If the patient deteriorates, call for assistance and begin basic life support.
• If general equipment is not available for continuous haemodynamic monitoring, call for assistance and get a colleague to locate the equipment.

Conclusion

A bed safety check should be the first task performed after handover.

Ensure that all equipment is working and ready to use, and familiarise yourself with the locations of additional emergency equipment such as the emergency trolley. If any equipment is not in the bed area, replace it immediately.

Additional Resources

• Australian Resuscitation Council & New Zealand Resuscitation Council, Standards for Resuscitation: Clinical Practice and Education, https://www.acccn.com.au/documents/item/165
• College of Intensive Care Medicine of Australia and New Zealand, Minimum Standards for Intensive Care Units, https://www.cicm.org.au/CICM_Media/CICMSite/CICM-Website/Resources/Professional%20Documents/IC-1-Minimum-Standards-for-Intensive-Care-Units.pdf
• Intensive Care New South Wales, Equipment, https://www.aci.health.nsw.gov.au/networks/icnsw/patients-and-families/equipment
• The Royal Hospital for Women, Emergency Equipment - Checking and Maintenance, https://www.seslhd.health.nsw.gov.au/sites/default/files/documents/EmergEquip.pdf

References

• Australian Resuscitation Council & New Zealand Resuscitation Council 2014, Standards for Resuscitation: Clinical Practice and Education, Australian Resuscitation Council & New Zealand Resuscitation Council, viewed 30 April 2020, https://www.acccn.com.au/documents/item/165
• Butcher, J T & Cooper, J S 2020, Bag Mask Ventilation (Bag Valve Mask, BVM), StatPearls, viewed 30 April 2020, https://www.ncbi.nlm.nih.gov/books/NBK441924/
• College of Intensive Care Medicine of Australia and New Zealand 2011, Minimum Standards for Intensive Care Units, College of Intensive Care Medicine of Australia and New Zealand, viewed 30 April 2020, https://www.cicm.org.au/CICM_Media/CICMSite/CICM-Website/Resources/Professional%20Documents/IC-1-Minimum-Standards-for-Intensive-Care-Units.pdf
• The Royal Hospital for Women 2016, Emergency Equipment - Checking and Maintenance, The Royal Hospital for Women, viewed 30 April 2020, https://www.seslhd.health.nsw.gov.au/sites/default/files/documents/EmergEquip.pdf