Principal elements for rotational therapy
Principal elements for rotational therapy
Here are key elements of the rotational bed protocol developed by VHA Southwest:
1 The patient must have the potential for recovery or positive outcome. "If a patient has a DNR [do not resuscitate] order, then it wouldn’t be appropriate to use this bed’s level of technology," says Sarann Nolen, RN, CETN, an enterostomal therapist (ET) at the Baylor University Medical Center in Dallas.
2 The patient should be hemodynamically unstable and thus unable to receive more traditional treatment. "Some patients are unable to tolerate physical turning by a nurse; their blood pressure drops, and the heart rate increases," says Nolen, who explains that turning on a rotational bed is less drastic than traditional turning.
3 The patient must be able to tolerate the rotational aspect of the bed for 18 to 24 hours. "You can turn off the rotational aspect of the bed and still have an air bed, which is appropriate to prevent skin breakdown," Nolen says. "But the bed is too expensive to be used in that manner. Patients who aren’t able to tolerate the rotation should be stepped down to another support surface."
4 The patient should be intubated and on a ventilator or paralyzed with the need for continuous pulmonary toileting. "Ask yourself two questions," says Nolen.
"Will the patient be on the ventilator for more than 72 hours? And will the patient need chest physiotherapy every hour?" If the answers to those questions are no, you won’t need the rotational bed, she says, explaining the bed also performs percussion on the chest to loosen secretions.
5 Trauma patients with chest injuries who do not have unstable spinal injury and who meet the criteria should receive a rotational bed within 24 to 48 hours of injury. The bed company says that the best results occur when the bed is used early in the treatment process, explains Nolen.
6 Discontinue the use of the bed if no improvement occurs after five days. Notify the family of the patient of this policy before the placement, says Nolen. "So they won’t think you are suddenly depriving their loved one of important therapy. Explain that the best results are achieved in the first five days."
7 Use rotational beds in the critical care unit only. "Formerly, we had patients transferred to the floor who would get out of the bed and walk down the hall," Nolen says.
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