Making an occcupied bed

Authors: V.Rednenko 

Editor: V.Rednenko 

Equipment for the practical skill:

• Simulated patient (patient manikin)
• Hospital bed with bedding
  • Mattress
  • Mattress pad
  • Bottom sheet
  • Draw sheet
  • Top sheet
  • Blanket
  • Bedspread
  • Pillow in pillowcase
• Clean linen
  • Mattress pad
  • Bottom sheet
  • Draw sheet
  • Top sheet
  • Pillowcase
  • Bath blanket
• Gloves
• Linen hamper

Clinical situation:

Change linen in an occupied bed

Order of the skill performance:

Preparatory stage:

• Introduce yourself
• Identify patient
• Obtain informed consent to the procedure (if the patient's condition allows it)
  • Give all the information to the person about what the procedure involves, including the benefits and risks, whether there are reasonable alternative, and what will happen without this procedure
  • Explain what you are going to do.
  • Ask the patient to consent to procedure.
  • Explain to the patient how he can help.
• Make sure you have the necessary equipment and put it on the over-bed table (the chair next to the bed)
• Sanitize your hands, put on gloves
• Prepare the patient bed:
• Raise the bed to a comfortable working height.
• Make sure the wheels on the bed are locked

Main stage:

Task 1: Remove and replace linen on the first fide of the bed

• Lower the head of the bed so that it is as flat as the person can tolerate.
• Remove the bedspread. If it is clean and can be reused, fold it and place it on a clean surface. Do the same with the blanket, if it can be reused.
• Loosen the top sheet at the foot of the bed. Cover the person and the top sheet with the bath blanket (to provide privacy and warmth). Ask the person to hold the edge of the bath blanket (or tuck the edges under the person’s shoulders) while you remove the soiled top sheet and place it in the linen hamper.

• Help the person roll toward you, onto his side. Raise the side rail and move to the opposite side of the bed.

• Adjust the pillow under the person’s head for comfort. Ensure good body alignment and make sure the person is covered with the bath blanket.
• Check the linen on the side where you are working for items the person may have left in the bed. If items were left in the bed, move them to a safe place.
• Loosen the dirty mattress pad, bottom sheet and draw sheet. Fanfold the dirty linen toward the person and tuck them against and slightly under his back.

• If the linen are soiled with body fluids, tuck a bed protector under the dirty linen and fold it back over them and the person’s back to prevent the clean linen from becoming contaminated.
• Remove and dispose of your gloves.
• Put the clean mattress pad on the bed with the center fold in the center of the bed. Unfold the mattress pad. If you are using a fitted mattress pad, fit the elastic corners over the edges of the mattress. If you are using a flat mattress pad, make sure the top edge is even with the head of the mattress.
Put the clean bottom sheet on the bed. If you are using a fitted sheet, fit the elastic corners over the edges of the mattress. If you are using a flat sheet:
• Put the flat sheet on the bed with the center fold in the center of the bed and the bottom edge even with the foot of the mattress. Make sure the sheet is positioned so that when you unfold it, the rough side of the hem stitching at the top of the sheet will be against the mattress. Unfold the sheet.
• Tuck the top of the sheet underneath the mattress at the head of the bed.
• Miter the top corner. With your palms facing up, continue tucking in the sheet on the side, all the way to the foot of the mattress.
• If a draw sheet is to be made into the bed, put the draw sheet across the middle of the mattress with the center fold in the center of the bed. Unfold the draw sheet. With your palms facing up, tuck the draw sheet under the mattress, tucking in the middle third first, then the top third and then the bottom third.
• Fanfold the opposite side of the clean linen toward the person.
• Flatten the fanfolded linen as much as possible. Help the person roll toward you, over the fanfolded linen.
• Adjust the pillow under the person’s head for comfort. Ensure good body alignment and make sure the person is covered with the bath blanket.
• Raise the side rail and move to the opposite side of the bed.

Task 2: Remove and replace linen on the second side of the bed

• Lower the side rail on the side where you are working.
• Put on a clean pair of gloves.
• Check the linen on the side where you are working for items the person may have left in the bed. If items were left in the bed, move them to a safe place.
• Loosen and remove the soiled linen and place them in the linen hamper.
• Remove and dispose of your gloves.
• Pull the clean, fanfolded mattress pad toward you until it is completely unfolded. If you are using a fitted mattress pad, fit the elastic corners over the edges of the mattress. If you are using a flat mattress pad, make sure it is aligned properly.
• Pull the clean, fanfolded bottom sheet toward you until it is completely unfolded. If you are using a fitted sheet, fit the elastic corners over the edges of the mattress. If you are using a flat sheet, tuck the top of the sheet underneath the mattress at the head of the bed, miter the top corner, and with your palms facing up, tuck in the sheet on the side, all the way to the foot of the mattress. Pull the clean, fanfolded draw sheet toward you until it is completely unfolded. With your palms facing up, tuck the draw sheet under the mattress, tucking in the middle third first, then the top third and then the bottom third.

• Help the person roll onto his back in the center of the bed. Adjust the pillow under the person’s head for comfort. Ensure good body alignment and make sure the person is covered with the bath blanket.
• Put the top sheet over the person with the center fold in the center of the bed and the top edge even with the head of the mattress. Make sure that the sheet is positioned so that when you unfold it, the rough side of the hem stitching at the top of the sheet will face up.
• Have the person hold the clean top sheet in place while you remove the bath blanket from underneath. Place the bath blanket in the linen hamper.

Task 3: Change the pillowcase

• Remove the pillow from under the person’s head.
• Remove the pillowcase from the pillow, and place it in the linen hamper.
• Hold the clean pillowcase at the center of the bottom seam.
• Turn the pillowcase inside out, back over the hand that is holding the bottom seam.
• With the hand that is holding the pillowcase, pick up the pillow at the center of one of the short ends and bring the pillowcase down over the pillow using your other hand. Fit the corners of the pillow into the corners of the pillowcase.
• Place the pillow under the person’s head, with the open end of the pillowcase facing away from the door.

Task 4: Tuck in the top linen and make a toe pleat

• Put the blanket on the bed with the center fold in the center of the bed and the top edge about 6 inches (15 cm) below the head of the mattress. Unfold the blanket.
• Put the bedspread on the bed with the center fold in the center of the bed and the top hem even with the head of the mattress. Unfold the bedspread.
• Together, tuck the top sheet, blanket and bedspread under the foot of the mattress. Miter the corners at the foot of the bed to hold the top sheet, blanket and bedspread in place.
• Fold the top of the bedspread down far enough to allow room to cover the pillow.
• Fold the top sheet down 6 inches over the blanket’s edge on each side of the bed to form a neat cuff.
• Standing at the foot of the bed, grasp both sides of the top covers about 18 inches (40 cm) from the foot of the bed. Pull the top covers up and toward the foot of the bed, making a 3- to 4-inch (7-8 cm) fold (called a toe pleat) across the foot of the bed.

Final stage:

• Ensure the person’s comfort and good body alignment.
• Adjust equipment for safety: Lower the bed to the level specified in the person’s care plan. Make sure the wheels on the bed are locked. Place the person’s method of calling for help within reach. Lower or raise the side rails according to the person’s care plan.
• Clean up your work area.
• Wash your hands.