Written by: Lores Vlaminck, MHCA Nurse Consultant, Lores Consulting

June 23, 2015

Today there are about 2.5 million hospital and nursing home beds in use in the United States. Between 1985 and January 1, 2009, 803 incidents of clients caught, trapped, entangled, or strangled in beds with rails were reported to the U.S. Food and Drug Administration. Of these reports, 480 people died, 138 had nonfatal injuries, and 185 were not injured because staff intervened. Many clients were frail, elderly or confused.For the purposes of this discussion, a ‘bedrail’ is any rail that has been added to a bed for turning, safety, security, and assistance.  They may be adjustable, “bolt-on, hook-on,” double, or removable.

The FDA (2010) has developed a brochure that can view by clicking here, along with staff educational tools FDA Bed Rail Staff Education. The Minnesota Department of Health survey and compliance team has identified gaps in the documentation of clinicians’ assessments of the clients’ functional and medical needs along with the discussions of the risks and benefits during their home care surveys. 

Use of bed rails should be based on clients’ assessed medical needs and should be documented clearly and approved by the interdisciplinary team.  This may include the physician, nursing staff and/or therapy clinicians.

• Bed rail effectiveness should be reviewed on a regular basis.
• The client’s chart should include a risk-benefit assessment that identifies why other care interventions are not appropriate or not effective if they were previously attempted and determined not to be the treatment of choice for the client.
• You may choose to seek a provider’s order for the bed rail including its description and use.

The care plan should include;

• Educating the client about possible bed rail danger to enable the client to make an informed decision and addressing options for reducing the risks of the rail use
• The process of reassessment for the need of the rail and ongoing communication of the risks and benefits

More information can be found at:
http://www.health.state.mn.us/divs/fpc/safety.htm

http://www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/GeneralHospitalDevicesandSupplies/HospitalBeds/ucm123676.htm

http://www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/HomeHealthandConsumer/ConsumerProducts/BedRailSafety/ucm362848.htm

It is strongly encouraged that home care providers include in their admission packets the FDA bed rail brochure and include the discussion of bed rails in your safety assessment of your client on admission and periodically (90 days) as needed.