General Guidance 1.4: Patient Support Surfaces
Overview
The guidance that follows applies to health equipment that includes examination tables, examination chairs, hospital beds, x-ray platforms, MRI/CT/PET scan platforms. This guidance is directed primarily towards individuals in the role of healthcare patients (e.g., hospital environment) or consumers (e.g., home environment). Much of the guidance in this subsection is based on a series of studies conducted by the RERC-AMI (national survey, focus groups, video-based accessibility and usability testing of devices in this category). Where noted, this guidance is also extracted from the Americans with Disabilities Act Accessibility Guidelines (ADAAG), which were written primarily for architectural access to a wide range of public spaces, including healthcare facilities.
1.4.1 The base of the device should not extend beyond the horizontal edge of the support surface.
Discussion: This is so as not to impede the ability to orient a wheelchair next to the device support surface with a minimal horizontal gap between the wheelchair seat and support surface to help facilitate transferring onto and off the surface. When wheelchair users perform manual transfers (for example using a transfer board), they need to place the wheelchair next to the transfer surface (for example an exam table) with a minimal horizontal gap between the wheelchair seat and adjacent surface.
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1.4.2 The base of the device should provide clearance for lift equipment.
Discussion: Many people with significant motor impairment such as paralysis are transferred from one surface to another using patient handling devices such as Hoyer lifts. Because this lift equipment is essential for many healthcare providers to allow safer and more efficient patient handling, it is important that patient support devices provide adequate clearance for optimal interaction between the device and lift equipment. The base of the patient support device needs to have space underneath or along both sides of the base, if the equipment is narrow, to accommodate the legs of portable mechanical lift equipment so that the patient can be suspended over the support surface before being lowered onto it.
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1.4.3 The height of the support surface should enable easy patient transfers.
Discussion: The support surface height should be at or move to a position low enough (19” max) for the patient to transfer onto and off it from a seated position.
1.4.4 The height of the support surface should be easy to adjust to suit the needs of potential healthcare patients and professionals.
Discussion: The support surface height should be easily adjustable (ideally with automatic power) to different heights. The support surface should adjust to a position high enough to accommodate tall healthcare providers and the range of medical procedures that may occur, and low enough (19 inches maximum) to accommodate patients who need to transfer on and off, even from a chair or wheelchair alongside. ... EXPAND
1.4.5 The stiffness of the surface padding should be appropriate to the application.
Discussion: The type of patient transferring that will occur onto and off the platform should dictate the stiffness of the surface padding so there is a balance between comfort and functionality. For example, platforms that require frequent transfers and short position maintenance times should have stiffer padding (especially so that patients who perform manual or self-transfers can get sufficient leverage). KEEP? EXPAND?
1.4.6 The support surface should be stable and safe for the patient at all times.
Discussion: The support surface should be stable at all times (i.e., should not move while the patient gets on or off). A stable platform is important for helping patients maintain their balance while using the platform, including while they are transferring on and off.
1.4.7 The support surface contact surfaces should be safe and comfortable for the patient.
Discussion: The support surface should not be slippery, have no sharp edges, and have sufficient padding and thermal insulation for the patient to be safe and comfortable. Armrests should be provided for support surfaces that require the user to assume a seated position, for both comfort and stability.
1.4.8 The support surface should be wide enough for all potential patients.
Discussion: The support surface should be wide enough so a patient can roll to a side or prone position with minimal need to lift and shift their center of gravity.For platforms on which patients lie down, a patient should be able to roll to a side or prone position with minimal need to lift and shift their center of gravity. For platforms on which patients stand, platforms that are wide enough for patients to assume a wide stance position increase the overall accessibility and safety of these devices, because often users who have balance impairments can overcome their limitations if they can stand with their feet relatively far apart and/or use their upper bodies to help them balance. Normally this implies a width of at least XX centimeters (XX inches). A healthcare facility may need to have larger equipment available in some of its rooms to provide care for bariatric patients.
1.4.9 The shape of the support surface should be adjustable to accommodate and maintain desired body postures.
Discussion: The support surface should be adjustable or have adjustable support features (e.g., for head, neck, back, lumbar region, leg, knee, foot, as appropriate) to support patients in various body postures and positions in a manner that optimizes their comfort. This is particularly important when patients need to maintain a static position, such as for imaging procedures. While these adjustments are normally controlled by the healthcare professional, for some applications, patients should be able to make adjustments themselves if no professional is present. This may involve support for specialized padding. EXPAND?
1.4.10 Effective leg supports should be provided.
Discussion: For patients with limited leg strength and control, instead of stirrups that support only the foot and require active user leg strength, or leg supports that support both the foot and the leg should be used to assist patients in keeping their legs in an appropriate position. It is also important that leg supports are able to be moved out of the way.
1.4.11 Straps and safety rails should be provided.
Discussion: If the patient is expected to sit alone or independently on the support surface, straps or safety rails should be present in case the patient experiences muscle spasms or loss of balance.
1.4.12 A non-obstructed path should be available for transferring.
Discussion: Any side rails, arm rests, leg supports, control unit cords, or other auxiliary equipment should be positioned or be able to be moved out of the way so as not to interfere with patients’ ability to transfer onto and off the platform.
1.4.13 The device should have integrated handholds to facilitate patient transfers.
Discussion: Regardless of the nature of the device or equipment, any support platform should have handholds (e.g., recesses, handles, railings, straps) integrated into the device design and placed at locations most appropriate for the intended tasks for safety and assisting patients with transferring on and off, positioning or repositioning their bodies, and maintaining static positions.
1.4.13.1 The diameter or width of the gripping surfaces of a handrail or grab bar shall be 1-1/4 in to 1-1/2 in (32 mm to 38 mm). If a non-cylindrical shape is used, it should provide an equivalent gripping surface.
Discussion:
1.4.13.2 If handrails or grab bars are mounted adjacent to a wall, the space between the wall and grab bar shall be 1-1/2 in (38 mm) (see Fig. 39(a), (b), (c), and (e)). Handrails may be located in a recess if the recess is a maximum of 3 in (75 mm) deep and extends at least 18 in (455 mm) above the top of the rail (see Fig. 39(d)).
Discussion: Many people with disabilities rely heavily upon grab bars and handrails to maintain balance and prevent serious falls. Many people brace their forearms between supports and walls to give them more leverage and stability in maintaining balance or for lifting. The grab bar clearance of 1-1/2 in (38 mm) required in this guideline is a safety measure to prevent injuries resulting from arms slipping through the gap between the rail and the wall. It also provides adequate gripping room. Motivated by: ADAAG §4.26, Handrails, Grab Bars, and Tub and Shower Seats.
Alternate shapes of handrails are allowable as long as they allow an opposing grip similar to that provided by a circular section of 1-1/4 in to 1-1/2 in (32 mm to 38 mm). Motivated by: ADAAG Appendix Note A4.26.2.
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1.4.14 For support surfaces that require the patient user to assume a seated position, armrests should be provided to enhance patient comfort, stability, and ease of transferring.
Discussion:
1.4.15 Controls for support surfaces should be located appropriately.
Discussion: Controls for support surface adjustments (e.g., height, back rest angle) should be located as appropriate for the support surface, patient, and situation (i.e., different locations for individuals not intended to get out of bed versus individuals who use hospital beds in their homes). If appropriate, controls for adjusting the support surface should be easy to reach, view, understand, and operate.
1.4.16 Devices should facilitate continuous communication between patients and providers.
Discussion: A continuous method of communication between the patient and provider should be provided (e.g., intercom system and visual cues). This is especially important when the provider is located in another room or when the patient has hearing or visual limitations.This is especially important when the provider is located in another room or when the patient has hearing or visual limitations. One means of enhancing orientation for a blind person is to provide stereo audio output with small speakers built into strategic parts of the medical equipment. For a different reason, if the equipment is noisy, audio output or music may be included in the system for patient comfort.
1.4.17 Consider providing audio or music output for patient orientation or comfort.
Discussion: One means of enhancing orientation for a blind person is to provide stereo audio output with small speakers built into strategic parts of the medical equipment. For a different reason, if the equipment is noisy, audio output or music may be included in the system for patient comfort.