Soma or Enclosure Beds... Cruel or not?

[Paws2people]

At my hospital we use Soma beds. Usually for the safety of dementia patients, or confused elderly ones. For awhile we weren't allowed to use them because family members of the patients and some employees deemed them as cruel "cages." In my opinion it is better to have a patient in a Soma bed versus posey vests, or wrist restraints, leathers, etc. Plus we have more CNA's available on the floor. Prior to these beds we had a ton of safety care/one to ones, in which a CNA would sit with these patients 24/7.

What is your hospital's restraint procedure for confused patients? Do you find these beds useful, or cruel?

[TheCommuter, BSN, RN]

I'd rather run in the room to a bed alarm going off and reorient my pt 20 times a night than feel like I'm caging them. Does this not just multiply agitation?!

These beds do not increase the patient's agitation as long as they have a diversion while in bed such as TV, towels to fold, newspaper, snacks, etc.

It's nice that your ratios are 1:6, but the ratios at my hospital run from 1:7 to 1:12 on both day and night shifts, so we do not have the time to keep running into the room. We also do not have money in the budget for 1:1 sitters. Long live vail beds.

[KelRN215, BSN, RN]

I've known of a few patients over the years (children) who have these beds even at home. They look like cages, but sometimes they're necessary.

[Swellz]

I'm learning to appreciate them. I think they agitate certain patients. I also think it is hard to keep them clean. I don't prefer them but then I don't prefer my patients to be disoriented either. I had a patient do push ups in one once. They keep patients safe and are better than restraints.

[catmom1, BSN, RN]

I had never heard of Vail beds before this either.

When I googled the term, I found several references to recalls of these beds and even one mention that the Vail beds were not to be manufactured any more because patients have asphyxiated by getting caught between the mattress and netting.

Are any of you knowledgeable folks aware of this issue?

Catmom :paw:

[Paws2people]

My workplace uses bed enclosures, also referred to as vail beds. While their appearance might disturb families, the only other alternatives are private sitters (not in the budget), frequent rounding (ain't nobody got time for that!), and seeing the patient sustain a broken hip after falling for the 15th time in a four hour period.

In my opinion, the vail bed is far better than the 100+ falls that would occur without it.

Agreed. Much better than a broken hip. Plus it keeps dementia pts and sundowners from wandering off.

Thanks for the alternate word vail bed. I hadn't heard that name. I believe Soma is a brand name. These beds always remind me of upside down playpens!

[Paws2people]

sistrmoon said:

I've never heard of these but I'm intrigued. We have a ton of one to ones, restraints, safety sits. Are they expensive? The appearance is pretty off putting though.

My hospital doesn't actually own these beds. When we need one, we call the "Soma" company. They send a certified tech who brings the enclosure bed. Then they assemble it onto our regular Hill-Rom beds. This whole process from ordering to assembling takes 24 hrs. I guess in essence, we rent the Soma beds as needed.

[Boog'sCRRN246, RN]

I had never heard of Vail beds before this either.

When I googled the term, I found several references to recalls of these beds and even one mention that the Vail beds were not to be manufactured any more because patients have asphyxiated by getting caught between the mattress and netting.

Are any of you knowledgeable folks aware of this issue?

Catmom :paw:

The recall you read about was specifically for the Vail Products company. Other companies manufacture similar beds, such as Posey and Soma. Posey's beds have an extremely thin mattress that I assume prevents patients from getting caught in between the mattress and netting.

We use these beds at my facility for impulsive patients that learn how to turn off their bed alarms and even certain TBIs. The patient is free to move around as much as they'd like while in the bed and they remain safe. I've never had a patient freak out about being in one of these types of beds; in fact, most appear to be much calmer.

[elkpark]

My hospital doesn't actually own these beds. When we need one, we call the "Soma" company. They send a certified tech who brings the enclosure bed. Then they assemble it onto our regular Hill-Rom beds. This whole process from ordering to assembling takes 24 hrs. I guess in essence, we rent the Soma beds as needed.

My facility rents them from a local provider, also. It takes ~24h to get one in the room and ready to use.

[sam1971]

Im not familiar with these beds at all but when i googled it , this came up...

Death of woman after placement in ‘bed cage’ highlights controversial medical practice | Florida Independent

[LadyFree28, BSN, LPN, RN]

Im not familiar with these beds at all but when i googled it , this came up...

Death of woman after placement in 'bed cage' highlights controversial medical practice | Florida Independent

Sounds like serious negligence.

When done correctly, most people are not placed in the beds and zipped up unless they are exhibiting behavior that compromises safety; pts also are supposed to be monitored frequently, and they are not supposed to be in the bed ATC; they should be with help ambulated or should have a diversion activity to prevent compromises to safety; skin checks and food and fluids should be offered, even engaging in conversation to determine whether the pts status has changed and the vail be can be discontinued; if applicable; although My experience the beds actually were a favorable outcome with all my pts; possibly due to the fact that my pts were neurologically compromised (TBI).

Even though we have one side of the story; it seems as the pt was not "released" from the bed; however, with good documentation; they may have been (if it has been resolved) able to resolve the case if all the proper steps when a pt is restrained were followed through as well.

[xoemmylouox, ASN, RN]

I have worked in a facilty that used a Posey Bed for a patient who had Huntington's Disease. It was the ONLY way to keep him and us safe. He was angry at the world (which I might be as well), his family refused to see him anymore (his children blamed him as one of them had been diagnosed as well), his wife divorced him and moved on, and he was a tall guy. We always had to have at least 2 of us when we provided care as he would fight like the dickens. It was a forever battle to keep that bed clean, but we would team up and made it work (we could bribe him with Little Debbie cakes). If it wasn't for that bed I don't know how any of us would have survived a shift.

[SeattleJess]

We don't have any enclosed beds. We have Hi-Lo beds that pretty much go to the floor to help prevent injuries if someone falls. We also have cushioned matts to put on either side of the bed on the floor.

Other than that, we have bed alarms that go off if the patients try to get out of bed, and mitts for patients who pull at tubes.

Many times they end up with a sitter because they keep challenging the bed checks.

Those beds sound way safer, but I could see how a family would be put off by it.

That's what we do. In Washington, restraints without a physician's order or patient consent are considered a violation of OBRA. A bedrail or an over-bed table that the resident can't move is considered a restraint and patients/residents must sign a waiver if they want them.

It's not like there's a perfect, no-harm option. There are risks and harms from both using and not using restraints. Injury and death risks on both sides of the equation. Sigh.