How to practice hospital bed rail safety

According to the U.S. Food and Drug Administration (FDA), between January 1, 1985 and January 1, 2013, the agency received reports of 901 incidents of patients caught, trapped, entangled or strangled in hospital beds. Most of those affected were frail, elderly or confused. Skilled nursing facilities mainly serve populations that could be impacted by bed injuries. That’s why it is important that long-term care facilities practice bed safety measures to protect their residents from injury while using their hospital bed.

Residents with memory, sleeping, incontinence, pain, body movement and unassisted walking problems could be at increased risk for bed injuries. FDA guidance on safe use of beds recommends that residents be carefully assessed for the best ways to keep them from harm. After the assessment, a number of measures could be used to keep residents safe while they are in their beds such as concave mattresses, roll guards or foam bumpers. For added safety, the FDA advises that facilities use beds that can be raised or lowered close to the floor to accommodate both resident and staff needs. Also, keep the bed in the lowest position with the wheels locked. If the resident is at risk of falling out of bed, place mats next to the bed, as long as this does not create a greater risk for accidents. When transferring residents, use transfer or mobility aids. Also, anticipate the reasons residents may get out of bed and meet those needs. Finally, monitor residents frequently.

Use of bed rails
In years past, physical restraints were used to keep residents safe in bed. However, physically restraining residents has come to be recognized as dangerous in recent times. Such practices are also counter to the spirit of person-centered care and are a direct violation of Resident’s Rights. Although not indicated for this purpose, bed rails are sometimes used as restraints. Properly and safely used, bed rails can help residents who are at risk of falling out of bed, especially if bed rail alternatives have proven unsuccessful. Bed rails can potentially benefit a resident by aiding in turning and repositioning in bed; providing a hand-hold for getting in or out of their bed; providing a sense of security and reducing the risk of falling out of bed. 

According to the Centers for Medicare & Medicaid Services, the use of bed rails must be deemed medically necessary and consent must be obtained from the resident or their representative before their installation. The FDA recommends that facilities make sure to choose the appropriate bed rail for the age, size and weight of the person using the bed rail. The bed rail should be installed using the manufacturer’s instructions. The agency advises the use of the proper size mattress for the bed or one with raised foam edges to prevent entrapment. To further reduce the chance of injury, facilities should try to minimize gaps between the mattress and side rails. There should be no gap wide enough to entrap a resident’s head or body. Finally, it is advisable that one or more sections of the bed rail be lowered.

Extra vigilance
When bed rails are in use, the FDA advises extra vigilance such as on-going assessments of a resident’s physical and mental status. The mattress and bed rails should also be regularly inspected to make sure they are still correctly installed. They should also be inspected for areas of possible entrapment or potential falls. Facilities need to be aware that gaps can be created by movement or compression of the mattress and should make adjustments. 

Keeping residents safe in bed is a combination of using equipment properly and being proactive about potential dangers. Bed rails should never be used as a substitute for regularly monitoring residents. Residents and their beds should be regularly assessed for potential problems. Finally, facilities should always follow manufacturer’s instructions and recommendations for use of beds and/or bed equipment.

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