What are bed rails used for in nursing homes?

According to the U.S. Food and Drug Administration (FDA), bed rails can be an important assistive device in certain situations, but their use requires careful assessment. In nursing homes, understanding what are bed rails used for is crucial for ensuring resident safety while also considering the significant risks involved.

Quick Summary

In nursing homes, bed rails are used for resident safety, providing a secure grab-handle for repositioning and exiting bed, and preventing falls during transport. However, their use is heavily regulated due to the potential for severe entrapment injuries and their classification as a physical restraint if not used properly.

Key Points

• Mobility and Support: Bed rails assist residents with repositioning and getting out of bed, promoting independence.

• Safety During Transport: They prevent residents from falling out of bed while being moved within the facility.

• Risk of Entrapment: Improper use or fitting of bed rails can lead to entrapment, which is a significant safety hazard.

• Restraint Classification: Bed rails can be considered a physical restraint if they prevent a resident from voluntarily leaving the bed and must be justified by medical necessity.

• Prioritizing Alternatives: Safer alternatives like low beds, floor mats, and bed alarms are now prioritized to reduce fall risks without the dangers of bed rails.

Understanding Bed Rails in the Nursing Home Setting

Bed rails, also known as side rails or safety rails, are protective barriers installed along the side of a bed. In a nursing home environment, their purpose has evolved significantly over the years. What was once seen as a standard fall prevention measure is now understood to be a complex issue requiring a balance between potential benefits and documented risks. Their application is dictated by federal guidelines and depends heavily on a resident's specific health needs and risks, emphasizing person-centered care rather than one-size-fits-all solutions.

The Shifting Perspective on Bed Rail Use

Historically, bed rails were widely deployed with the intention of keeping residents from falling out of bed. However, incidents of entrapment, where a resident becomes caught within the rails or between the rail and the mattress, led to a reevaluation of their safety. Frail, elderly, or cognitively impaired residents are particularly vulnerable to these risks, which can result in serious injury or even death. This critical understanding has led to the development of strict regulatory standards and a push toward restraint-free care, with bed rails being categorized as a restraint when they restrict a resident's voluntary movement without medical necessity.

Primary Uses for Bed Rails in Nursing Homes

Despite the risks, bed rails continue to serve legitimate, therapeutic functions for certain residents. These uses are carefully determined by the resident's care team through a comprehensive assessment.

• Mobility Assistance: For many residents, bed rails are used as a sturdy hand-hold. They can use the rails to help with repositioning themselves in bed, sitting up, or safely transferring out of bed. This promotes independence and reduces the strain on both the resident and care staff.
• Providing a Sense of Security: Some residents, particularly those who are disoriented or have visual impairments, may feel more secure and comfortable with the presence of a rail. It can act as a physical landmark, helping them orient themselves within the bed.
• Transport Safety: When a resident is being moved while in their bed, either within the facility or for appointments, the bed rails ensure they do not fall out during transport.
• Following Specific Medical Orders: In certain medical conditions, such as after specific surgeries or for patients with controlled body movements, a physician may prescribe the use of bed rails as part of a therapeutic plan. These instances must be documented and regularly reassessed.

Weighing the Benefits Against the Risks

Before implementing bed rails, a nursing home must conduct a thorough, individualized assessment. This process weighs the potential benefits for the resident's specific needs against the known risks. The following table provides a comparison of these factors.

Potential Benefits	Potential Risks
Increased Independence: Assists residents with mobility, allowing them to reposition themselves more easily.	Entrapment and Strangulation: Gaps between rails, or between the rail and the mattress, can cause a resident to get a limb, head, or torso trapped.
Improved Confidence: Provides a psychological sense of security for residents who fear falling.	Increased Risk of Injury from Falls: Residents with impaired cognition may attempt to climb over the rails, leading to more serious falls from a greater height.
Enhanced Transport Safety: Prevents a resident from falling out of bed during movement within the facility.	Agitation and Restriction: The presence of bed rails can make some residents feel trapped, leading to agitation and behavioral issues.
Access to Controls: Rails with integrated controls for bed positioning can aid residents in adjusting their bed to their comfort.	Restricted Mobility: Rails can prevent a resident from leaving the bed to perform necessary functions, such as going to the restroom, and may lead to a loss of physical function.

Alternatives to Bed Rails

Due to the significant risks associated with bed rails, many nursing homes now prioritize alternatives wherever possible. These strategies focus on creating a safer environment without physical restrictions.

1. Low Beds and Floor Mats: Adjustable-height beds can be lowered to a height that reduces the severity of a fall. Soft floor mats can also be placed beside the bed to cushion an accidental fall.
2. Bed Alarms: Pressure-sensitive alarms can be placed on the bed or floor. These systems alert staff when a resident attempts to exit the bed unassisted, allowing for a timely response.
3. Personalized Mobility Aids: Devices such as transfer poles, trapezes, and grab bars can provide a secure point of leverage for a resident to move and exit the bed. These are often safer and more targeted to a resident's specific needs.
4. Scheduled Toileting and Needs Anticipation: Regularly checking on residents and anticipating common needs like hunger, thirst, or toileting can reduce the motivation for them to get out of bed on their own.
5. Environmental Adjustments: Ensuring the resident's belongings, call bell, and personal items are within easy reach can prevent them from reaching or climbing out of bed to retrieve them.

Regulatory Guidance and Best Practices

Government agencies and industry organizations provide clear guidance on the safe use of bed rails. The FDA, for instance, offers a comprehensive guide on bed safety that outlines potential risks and promotes safe practices. This includes regular inspections of all bed rail systems to ensure proper function and fitting. Additionally, the Centers for Medicare and Medicaid Services (CMS) regulate the use of physical restraints, which includes bed rails, mandating that they only be used as a last resort and with proper justification. For more details on safe bed rail practices, visit the FDA's official guide on bed safety.

Conclusion: A Balanced, Individualized Approach

Bed rails are not a simple safety solution but a medical device with both benefits and severe risks. In the nursing home context, their use must be a well-considered, individualized decision based on a resident's specific needs, not as a blanket policy. Modern, high-quality care emphasizes restraint-free alternatives and frequent reassessment to ensure residents maintain their independence and safety. By understanding the complexities and regulatory requirements surrounding bed rails, caregivers can make informed choices that truly serve the best interests of the residents they support.

Frequently Asked Questions

Are bed rails in nursing homes considered a restraint?

Yes, bed rails can be considered a physical restraint if they restrict a resident's voluntary movement or prevent them from getting out of bed. Their use as a restraint requires a physician's order and proper documentation.

Who decides if a resident needs bed rails?

The decision to use bed rails is made by the resident's healthcare team, which includes a doctor, nurses, and therapists, after a comprehensive assessment of the resident's mobility, cognitive state, and fall risk.

What are the biggest dangers of bed rails in nursing homes?

The most significant dangers include entrapment (a resident getting caught in gaps), strangulation, and serious falls from a greater height when a resident attempts to climb over the rail.

Can a resident or family member request bed rails?

Yes, a resident or family member can request bed rails. However, the nursing home must still conduct a full risk-benefit assessment and evaluate if safer alternatives are available before approving their use.

What are some safe alternatives to bed rails?

Safer alternatives include using low beds, placing cushioned floor mats next to the bed, using bed and chair alarms to alert staff, and installing assistive devices like grab bars or trapezes.

Are all bed rails the same?

No, bed rails vary in length and design. Some are half-length, leaving a gap for easier entry and exit, while others are full-length. The choice of rail must be appropriate for the resident's needs and the bed's design to minimize entrapment risks.

What is the role of the FDA regarding bed rails?

The FDA regulates hospital and medical device beds, including bed rails, to ensure they meet safety standards. They also issue guidance and warnings to healthcare providers and the public about the benefits and risks of bed rail use.