Soma or Enclosure Beds... Cruel or not?

SeattleJess · Aug 27, 2014

Holy Guacamole. I work on a medical floor that specializes and Geriatrics and we have TONS of confused/dementia patients. I've never seen these beds. We ONLY use restraints of a patient it going to hurt someone, and sometimes not even then. (We had a pt pour coke on a nurse, then throw things at me, then pour coffee on a tech and still nothing). We are 6:1 at night. Sometimes we have half of those pts confused. We use bed alarms to prevent falls, ace wraps to try to keep IVs in. If that doesn't work we get a sitter. I honestly don't think the idea of those beds. It does seem cruel to me. 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?!

I so much wish that everyone who needs it could afford 1:1 care. Instead, the responsibility for this care is added to the already impossible list of care responsibilities that CNAs have for everyone on the unit. What a Herculean task!

ama3t · Aug 27, 2014

I don't consider that to be a CNA task. We use alot of bed alarms and my coworkers are fantastic. If a bed alarm goes off everyone in earshot comes running. Our patients can't turn off their own bed alarms because they can't reach to turn them off without first setting it off.

I mean ultimately if it works it works. But most of the patients I have on bed alarms I'm pretty sure would be very agitated if they were in one of these. Not everyone, but alot of them. People people with dementia, especially when its just moderate, can still understand that they are "trapped."

We only get a sitter if they are very agitated or are ambulatory but at risk for trying to leave and have a 6404. I didn't mean to imply we get 1:1 for everyone trying to get out of bed, we definately don't have the funds for that either.

Paws2people · Aug 28, 2014

Thank you everyone for weighing in on this topic :)

Most of our patients are calmer when in these beds. Sometimes I'll catch some of the men getting naked and on all fours. Never the women. Odd? Lol

I have yet to see anyone pulling on the thick netting, or ripping it, etc. It is very sturdy. It's not thin netting. Hard to explain unless you've seen a Posey or Soma brand enclosure bed. With kind we use, you can't fall between the mattress and the netting. There is no room.

As as for cleaning these beds... I often wonder after the company comes and disassembles them and they are returned, are they sterilized? What is the disinfecting procedure on their end? I hope it's cleaned thoroughly. Ugh, I shudder at the thought... :eek:

TheCommuter, BSN, RN · Aug 28, 2014

As as for cleaning these beds... I often wonder after the company comes and disassembles them and they are returned, are they sterilized? What is the disinfecting procedure on their end? I hope it's cleaned thoroughly.

We've never had to rent the vail beds that we use. This is because my workplace (a small post acute specialty hospital) outright owns several vail beds, which is convenient for nursing staff who can simply walk to the clean supply room and obtain one whenever the doctor orders it.

Our in-house environmental services staff (a.k.a. housekeeping) is responsible for disinfecting the vail beds after they're no longer in use and returning them to the clean supply room.

friggasdistaff · Aug 28, 2014

The patient in question didn't die as a result of being placed in the bed. She died two weeks later at another facility. Her son-in-law claimed it was because she was despondent from being placed in the bed. There were no injuries from the bed itself, and the investigating body felt there was no merit to his claim. The title of the article was sensationalizing media at its best.

studentnursemon86 · Aug 28, 2014

Wow. Bedside tables aren't considered a restraint. All 4 bedrails up is, as well as placing a bed against a wall with 2 bed rails up.

We would need a doctor order for that as well.

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.

imintrouble, BSN, RN · Aug 28, 2014

We could have used a couple of those last week.

Paint it pink, add some tulle and sequins and my granddaughter would think it was a princess bed

Karou · Aug 29, 2014

I used to work at a facility that used vail beds. We never once had a patient get injured in one. My current facility has a policy against them. I miss them often...

nopatientfalls · Oct 31, 2014

This is a really great discussion on the use of Safety Canopies. I never use the word "Cage", I prefer Safety Canopy. There is some great feedback here and I just wanted to clarify a few things on this thread.

1. Please do not call these Vail Beds. Vail went out of business about 8 years ago in an FDA recall because their bed was very unsafe with major defects and it was just a dangerous product with no warning labels and a bottom that did not allow for breathing or drainage. Although it was pretty safe when used in a hospital with nursing supervision, where they ran into trouble was with putting patients in the home in the Vail bed and you can only imagine what would happen. A bad combination of a defective product and no nursing supervision. They were recalled by the FDA and have been gone for over 8 years. Unfortunately it gave a black eye to all Safety Canopies. the name stuck and nurses still call all Safety Canopies "Vail Beds". Please don't. It only takes one family member to overhear their loved one is in a "Vail Bed" and Google it and you will have a mess on your hands.

2. The Soma Safety Canopy fits over your hospital bed, whether it is Hill-Rom, Stryker or Sizewise. It allows for the head up and all other functions of your bed that you are already used to. Everything you love about your beds, and don't love about your beds, it is your bed with a Soma around it of course.

3. Posey beds replace your hospital beds. it is an all in one. With the Posey bed you are not able to put the head up with At Risk patients. You have to buy separate Posey Cushions to achieve head up status and then you have to buy more Posey cushions to stuff into the entrapment zones. You don't have this issue with the Soma. Because you are using your hospital bed, Soma is just the netting around the bed and so it is much safer and useful. Almost every patient in a safety canopy would be "At Risk" and almost all patients on a MedSurgg/Tele floor will have their head up at some point.

4.Nurses views on Safety Canopies usually break into two groups. Those who have used them, usually like or love them, those who have never used them or have just seen a picture, don't like them or hate them. That is it. There are a lot of myths and misperceptions about Safety Canopies and those who have not been educated about them or used them with proper education are left to guess and wonder about the patient and the families.

5. I have found the families, if spoken to prior to seeing their loved one in a Safety Canopy, are far more understanding and appreciative. Usually for 2 reasons. 1. they came from another hospital or even this hospital where they were strapped down and 2. they know the difficulty and challenge of keeping their loved in bed at home and often want one for when their loved one goes home.

6. Most nurses who have not used Safety Canopies don't know or are not aware of the Cocooning or Swaddling and calming effect of the Canopy. this is a real phenomenon with these. The patients will actually calm down and therefore less meds for behaviors. What does vary by patient and by condition is how long it takes patients to "Cocoon". Some may take 3 hours and others 15 minutes, but over 90% will cocoon. You just have to be patient and let them do their thing and get there.

7. Cleaning and Disinfecting. The Soma Safety Canopies are delivered within 4 hours and usually 2 hours. they are cleaned and disinfected by the distributors or the company, not the hospital. They are also set up and taken down all within the 4 hour window. When Hospitals own their own Safety Canopy it is most likely not being cleaned properly or at all. I have seen some of the comments on this thread affirm that. I have seen it many times myself.

8. These Safety Canopies rarely make an impact on the fall rates or sitter usage if they are just simply on contract. You have to have a fall prevention program with it that supports their use for the right candidates. without the education and training Hospitals will use them sparingly and probably for the wrong patients. there is a lot that has to go into the house wide rollout and proper policies and procedures for restraints and utilization criteria.

9. There was some discussion about the patient who apparently died as a result of the use of the Soma Safety Canopy in Florida. First of all it was probably not a Soma, there is no distribution in Florida and no Somas in Florida. But potentially someone got a hold of one and brought it to Florida. The patient was in a Safety Canopy at the hospital. The patient was discharged to a nursing home and died in the nursing home a few weeks after discharge. How is this this fault of a Safety Canopy? There was never any thing attributed to the Soma, as it probably was not a Soma and if it was a patient dying 2 weeks later in a nursing home certainly would not be attributed to a net bed they used weeks prior in an inpatient setting.

10. Safety Canopies have been around for about 30 years now. They are a very effective tool for those patients who fit the following criteria. 1. Upon assessment to the unit, the patient is at high risk for falls and, and, and, very importantly 2. Exhibiting Behaviors like not using the call button, climbing over the rails, teach back is not going anywhere. those two criteria are the best way to identify candidates.

11. Sitters do not reduce falls. There are about 8 studies on this now and although sitters are expensive, they just have not had an impact on fall rates. Safety Canopies do. when zipped up properly, 100% of the time, the patient can not fall.

For any questions or comments you can look me up on Twitter at @nohospitalfalls

i hope this helps. These are not available in every city but they should be.

brandy323 · Dec 4, 2017

where are these facilities located? Does anyone have the names?

MunoRN, RN · Dec 5, 2017

where are these facilities located? Does anyone have the names?

What are the "these facilities" you're referring to?

allnurses Guide · Dec 5, 2017

I've never heard of these before. Can someone post a photo?

Vail bed images - Google Search