The use of half bed rails in ALF’s is not uncommon. AHCA regulations d0 allow the use of half bed rails if certain criteria are met.
ST – A0030 – RESIDENT CARE – RIGHTS & FACILITY PROCEDURES the use of physical restraints by a facility must be reviewed by the resident ‘ s physician annually. Any device, including half-bed rails, which the resident chooses to use and can remove or avoid without assistance, is not considered a physical restraint. The use of physical restraints is limited to half-bed rails as prescribed and documented by the resident’s physician with the consent of the resident or, if applicable, the resident’s representative, designee or the resident’s surrogate, guardian, or attorney.
Full bed rails may only be used if the resident is receiving hospice services. In this article, I want to cover serious issues that happen a lot more than you can imagine. Issues ranging as serious as resident deaths due to entrapment and entanglement.
Bed Rail Entrapment Statistics
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 patients* 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 a nonfatal injury, and 185 were not injured because staff intervened. Most patients were frail, elderly or confused.
The Benefits and Risks of Bed Rails
Potential benefits of bed rails include:
- Aiding in turning and repositioning within the bed.
- Providing a hand-hold for getting into or out of bed.
- Providing a feeling of comfort and security.
- Reducing the risk of patients falling out of bed when being transported.
- Providing easy access to bed controls and personal care items.
Potential risks of bed rails may include:
- Strangling, suffocating, bodily injury or death when patients or part of their body are caught between rails or between the bed rails and mattress.
- More serious injuries from falls when patients climb over rails.
- Skin bruising, cuts, and scrapes.
- Inducing agitated behavior when bed rails are used as a restraint.
- Feeling isolated or unnecessarily restricted.
- Preventing patients, who are able to get out of bed, from performing routine activities such as going to the bathroom or retrieving something from a closet.
Most patients can be in bed safely without bed rails. Consider the following:
- Use beds that can be raised and lowered close to the floor to accommodate both patient and health care worker needs.
- Keep the bed in the lowest position with wheels locked.
- When the patient is at risk of falling out of bed, placemats next to the bed, as long as this does not create a greater risk of an accident.
- Monitor patients frequently.
- Anticipate the reasons patients get out of bed such as hunger, thirst, going to the bathroom, restlessness and pain; meet these needs by offering food and fluids, scheduling ample toileting, and providing calming interventions and pain relief.
When bed rails are used, perform an on-going assessment of the patient’s physical and mental status; closely monitor high-risk patients. Consider the following:
- Use a proper size mattress or mattress with raised foam edges to prevent patients from being trapped between the mattress and rail.
- Reduce the gaps between the mattress and side rails.
In closing, if you do feel that bed rails are absolutely necessary please make sure to follow the last two safety suggestions of Use a proper size mattress or mattress with raised foam edges to prevent patients from being trapped between the mattress and rail. Reduce the gaps between the mattress and side rails. Continue to make routine inspections of bed rails making sure the above is done and that the bed rails are properly and securely attached to the bed.
Any device, including half-bed rails, which the resident chooses to use and can remove or can avoid without assistance, is NOT considered a physical restraint. However you must make sure the items listed below are completed.
1.You must have a physician’s order for a Half Bed Rail
2.The order needs to be renewed once a year.
3.The resident’s 1823 needs to mention the bed rails.
4.If your resident is on hospice this is the ONLY time you may use a full bed rail.