What is the use of side rails to keep the patient in the bed?

According to the FDA, bed rails offer potential benefits like improved mobility and security, but also pose serious risks including entrapment and falls. This critical assessment is vital for understanding what is the use of side rails to keep the patient in the bed?

Quick Summary

Side rails are used to assist with a patient's movement, provide a sense of security, and aid with repositioning, not primarily to confine them. They serve as a mobility aid, but their use requires careful assessment to prevent serious entrapment risks and avoid acting as a restraint.

Key Points

• Mobility Aid, Not Restraint: Side rails are ethically used to assist with movement, not to confine a patient, a critical distinction emphasized by healthcare authorities like the FDA.

• Entrapment is a Major Risk: Gaps between the rails, mattress, and bed frame can lead to serious entrapment injuries, making proper installation and fit crucial.

• Individual Assessment is Essential: A patient's physical and mental status must be assessed to determine if side rails are appropriate and to consider less restrictive alternatives.

• Safer Alternatives Exist: Low beds, floor mats, and trapeze bars offer effective fall prevention methods without the risks associated with side rails.

• Risks Outweigh Benefits for Some: For confused or agitated patients, side rails can increase anxiety and the risk of more dangerous falls.

Understanding the Purpose of Bed Side Rails

The perception of bed side rails often conjures an image of a patient being contained or restrained. In reality, the modern and ethical use of side rails in a healthcare or home setting is more nuanced and patient-centered. Their primary function is to serve as a supportive aid for the patient, facilitating movement, independence, and comfort. However, a significant misunderstanding exists regarding their use, especially in vulnerable populations such as the elderly or those with cognitive impairments. Historically, they were overused as restraints, a practice now widely discouraged due to serious safety concerns. Patient safety and independence should always be the priority when considering their application.

Benefits of Properly Used Side Rails

When implemented correctly after a thorough patient assessment, side rails offer several distinct advantages that can significantly improve a patient's quality of life and safety.

• Mobility and Repositioning: Side rails provide a sturdy handhold for patients to help pull themselves up, turn in bed, or reposition their body independently. This reduces caregiver strain and promotes a sense of autonomy for the patient.
• Security and Comfort: For some patients, the presence of a side rail can offer a sense of security, particularly for those who may feel unsteady or afraid of falling out of bed during sleep or transfers.
• Assistance with Transfers: As a stable point of contact, a side rail can help a patient transition from a lying to a seated position, and from the bed to a wheelchair or walker, making transfers safer and smoother.
• Easy Access to Controls: Some bed systems integrate controls for bed height and position directly into the rails, providing easy access for the patient.

Critical Safety Considerations and Risks

Despite their benefits, side rails are not without risks. The FDA and other regulatory bodies emphasize that risks must be carefully weighed against potential benefits through an individualized assessment.

• Entrapment: This is the most serious risk associated with bed rails. Gaps can exist between the rail, mattress, and bed frame, posing a risk of a patient's head or body becoming trapped, potentially leading to asphyxiation or injury.
• Increased Fall Height: For patients who attempt to climb over a raised rail, the fall distance is greater, increasing the risk of serious injury compared to a fall from a lowered bed.
• Feelings of Confinement: For patients with cognitive impairments like dementia, a raised rail can induce agitation, anxiety, and the feeling of being unnecessarily restricted or trapped.
• Skin Injuries: Poorly designed or installed rails can cause cuts, scrapes, or bruising to a patient's skin.

Bed Rails vs. Physical Restraints

A crucial distinction must be made between using side rails as a mobility aid and their application as a physical restraint. The Joint Commission states that if raising side rails prevents a patient from voluntarily exiting the bed, and they have the physical ability to do so, it is considered a restraint. This practice is heavily regulated and requires a physician's order and continuous assessment. However, if a patient is recovering from anesthesia or has involuntary movements and is not physically able to exit the bed, the use of rails to prevent an inadvertent fall is not considered a restraint. The intent behind the use is the key differentiator.

Alternatives to Side Rails for Enhanced Safety

Many safer and more effective alternatives to traditional side rails are available, especially for patients at high risk of entrapment or falls. These alternatives focus on fall prevention without compromising mobility.

1. Low Beds: Using an adjustable bed that can be lowered close to the floor minimizes the risk of injury if a patient falls out.
2. Floor Mats: Placing cushioned, non-slip mats on the floor next to the bed provides a soft landing and further cushions any potential fall.
3. Bed Alarms: These sensory devices alert caregivers when a patient attempts to exit the bed, allowing for a timely response.
4. Trapeze Bars and Assist Poles: These devices are securely mounted to the bed frame or ceiling and give patients a safe, sturdy handhold for repositioning.
5. Concave Mattresses: These mattresses feature raised foam edges to help prevent a patient from rolling out of bed.

Comparison of Side Rails and Safer Alternatives

Feature	Side Rails	Alternatives (Low Beds, Mats, Alarms)
Primary Use	Mobility assistance, feeling of security, patient repositioning	Proactive fall prevention, minimizing injury risk
Restraint Risk	High risk if misused; can be legally considered a restraint	Very low to non-existent
Entrapment Risk	Significant risk, especially with improper mattress fit	Non-existent
Patient Autonomy	Can restrict freedom of movement if used improperly	Actively promotes patient mobility and independence
Monitoring	Requires regular monitoring and assessment	Often used in conjunction with monitoring (e.g., bed alarms)
Cost	Can be part of a rental bed system; portable rails vary widely	Variable; floor mats and alarms can be cost-effective

Proper Assessment and Best Practices for Use

Any decision to use side rails should be preceded by a thorough, individualized patient assessment. This process should evaluate the patient's mobility, cognitive status, risk of falling, and medical conditions. The following best practices, advocated by regulatory bodies like the FDA, must be followed:

• Individualized Care Plan: Integrate the use of side rails into a comprehensive care plan, considering alternatives first.
• Regular Inspections: Routinely check the bed frame, mattress, and rails for proper fit to eliminate entrapment gaps.
• Educate Patients and Families: Ensure the patient and their family understand the purpose, benefits, and risks of side rails.
• Manufacturer Instructions: Always follow the manufacturer's instructions for installation and usage to ensure the rails are compatible with the bed and mattress.

Conclusion

Understanding what is the use of side rails to keep the patient in the bed is vital for providing safe, ethical, and effective senior care. The shift in healthcare from a paternalistic model of confinement to one centered on patient autonomy has re-contextualized the role of side rails. They are tools for assistance and mobility, not restraints, and their use requires careful consideration of both benefits and significant risks. By following proper assessment procedures, exploring safe alternatives, and adhering to best practices, caregivers can enhance patient safety and quality of life. For further authoritative guidance, a resource like the FDA's guide on bed safety can provide invaluable information on making informed decisions.

Visit the FDA's Guide to Bed Safety

Frequently Asked Questions

Are side rails considered a physical restraint?

Side rails are considered a physical restraint if they prevent a patient from voluntarily leaving the bed. However, if used to prevent an inadvertent fall for a patient who is unable to leave the bed due to sedation or illness, they may not be classified as such.

What is the primary purpose of bed side rails?

The primary purpose is to provide assistance with mobility, such as helping a patient to reposition themselves, sit up in bed, or get in and out of the bed safely, as well as providing a sense of security.

What are the biggest dangers of using bed side rails?

The most significant dangers include entrapment in the gaps between the rails and the mattress, and more severe injuries from falls that occur when a patient attempts to climb over the rails.

What are some safe alternatives to using bed rails for fall prevention?

Safe alternatives include using low beds, placing floor mats next to the bed, implementing bed or motion sensor alarms, and installing trapeze bars or assist poles for support.

Can I use bed rails for someone with dementia?

Using bed rails for individuals with dementia is risky and not recommended as a default solution. They can increase agitation and the risk of a more serious fall if the person attempts to climb over. A thorough assessment and alternatives are preferable.

How can caregivers ensure bed rails are used safely?

Caregivers should ensure the rails are properly installed according to the manufacturer's instructions, check regularly for proper fit with the mattress, and perform ongoing assessments of the patient's condition.

Do bed rails on hospital beds differ from those for home use?

Yes, hospital bed rails are often part of a 'bed system' and are designed to work with a specific bed frame and mattress. Portable rails for home use must be carefully checked for compatibility to avoid entrapment gaps.