A Comprehensive Guide: What Are the Reasons, Guidelines, and Safety Precautions for Bed Rails?

With thousands of hospitalizations from bed rail-related injuries, understanding safety is paramount. This guide covers what are the reasons, guidelines, and safety precautions for bed rails to ensure they are a help, not a hazard.

Quick Summary

Bed rails are used to prevent falls and aid mobility but require strict adherence to safety guidelines. Proper use involves risk assessment, correct installation, and awareness of entrapment dangers to ensure patient safety.

Key Points

• Risk vs. Benefit: Bed rails offer fall prevention but carry significant risks of entrapment and injury if not used correctly.

• Assessment is Non-Negotiable: A healthcare professional must assess a person's physical and cognitive state before a bed rail is considered.

• Installation is Key: Most incidents occur from gaps. The rail must be compatible with the bed and mattress and installed perfectly.

• Know the 7 Zones of Entrapment: Be aware of the seven specific areas defined by the FDA where a person can become trapped.

• Rails Are Not for Everyone: Individuals with confusion or dementia may be at higher risk of injury from climbing over rails.

• Consider Alternatives First: Safer options like low beds, floor mats, and bed alarms should always be considered.

Introduction: Balancing Safety and Risk with Bed Rails

Bed rails, also known as side rails or bed safety rails, can seem like a simple solution for preventing falls in older adults or those with mobility issues. While they can be an effective tool for some, they also introduce serious risks, including injury and fatal entrapment, if not used correctly. The decision to use a bed rail should never be taken lightly. It requires a careful assessment of the individual's needs, a clear understanding of the potential dangers, and strict adherence to safety protocols from regulatory bodies like the FDA. This guide provides an in-depth look at the appropriate use of bed rails, from the initial reasons for considering one to the critical steps needed to ensure safety.

The Primary Reasons for Using a Bed Rail

Bed rails are typically recommended for several key reasons, primarily centered around patient safety and mobility assistance. A thorough evaluation by a healthcare professional should determine if a bed rail is the most appropriate intervention.

• Fall Prevention: This is the most common reason. For individuals who are at risk of rolling or falling out of bed, a properly installed rail can serve as a physical barrier.
• Mobility Assistance: Rails can provide a firm handhold for individuals who need help repositioning themselves in bed, or assistance when moving from a lying to a seated position or from the bed to a chair or walker.
• Feeling of Security: For some individuals, the presence of a rail can provide a sense of comfort and security, reducing anxiety about falling during the night.
• Access to Controls: In some hospital bed setups, the rails may house controls for the bed's positioning, a nurse call button, or a television, making them easily accessible.

Official Guidelines for Safe Bed Rail Use

To mitigate risks, organizations like the U.S. Food and Drug Administration (FDA) have established guidelines. These are not just suggestions; they are critical for preventing serious injury. The core of these guidelines involves assessment, proper fitting, and regular monitoring.

Step 1: Conduct a Thorough Patient Assessment

Before installing a bed rail, a healthcare provider should evaluate the patient. A bed rail is not suitable for everyone. Consider:

• Cognitive Status: Individuals with dementia, delirium, or confusion may try to climb over the rail, leading to a more serious fall from a greater height.
• Physical Ability: Can the person reposition themselves to avoid entrapment? Are they strong enough to use the rail for assistance without it becoming a hazard?
• Body Size: The patient's size must be considered to ensure there are no gaps between the mattress and the rail where they could become trapped.

Step 2: Ensure Correct Installation and Fit

Improper installation is a leading cause of bed rail incidents. Always follow the manufacturer's instructions. Key checks include:

• Compatibility: The rail must be compatible with the specific bed frame and mattress being used.
• No Gaps: Once installed, check for any gaps between the rail and the side of the mattress, at the headboard, and at the footboard. A person's head, neck, or chest can get caught in these gaps.
• Mattress Sizing: The mattress must be the correct size and thickness for the bed frame to prevent dangerous gaps from forming when the mattress is compressed.

Step 3: Regular Inspection and Maintenance

Bed rails are not a 'set it and forget it' device. They require ongoing attention.

• Daily Checks: Caregivers should check that the rail is firmly in place each day.
• Routine Maintenance: Follow the manufacturer's guidelines for checking and tightening hardware.
• Monitor the Patient: Continuously observe how the patient interacts with the rail to ensure it remains a safe and effective tool for them.

Comparison of Common Bed Rail Types

Rail Type	Description & Best For	Pros	Cons
Portable/Tool-Free Rails	Rails that slide between the mattress and box spring. Best for home-style beds and individuals needing minimal assistance.	Easy to install, portable, affordable.	Less stable, higher risk of creating gaps if not a perfect fit.
Hospital Bed Rails	Integrated directly into a hospital-style bed frame. Best for individuals with complex medical needs requiring frequent repositioning.	Most secure and stable, designed for the specific bed.	Not usable on home beds, part of an expensive bed system.
Bed Handles/Grab Bars	Smaller, single-purpose rails designed only for assistance in getting in and out of bed.	Excellent for mobility support, less restrictive.	Offers no protection from rolling out of bed.
Half-Length Rails	Cover only the upper portion of the bed. Designed to prevent rolling out while still allowing the user to exit from the foot of the bed.	Good balance of fall protection and freedom of movement.	Still carries entrapment risks; may not be suitable for restless sleepers.
Full-Length Rails	Extend the entire length of the bed. Generally discouraged in most settings due to high entrapment and restraint concerns.	Provides maximum barrier against falling out.	Considered a form of restraint, high risk of entrapment and agitation.

Critical Safety Precautions and Entrapment Risks

The most severe risk associated with bed rails is entrapment. The FDA has identified seven specific areas where a person can get dangerously stuck. Understanding these is essential for any caregiver.

1. Zone 1: Within the rail itself.
2. Zone 2: Between the bottom of the rail and the top of the mattress.
3. Zone 3: Between the rail and the mattress.
4. Zone 4: Between the bottom of the rail and the mattress, where the rail support ends.
5. Zone 5: Between the headboard and the end of the rail.
6. Zone 6: Between the footboard and the end of the rail.
7. Zone 7: Between the headboard and the mattress.

To learn more about preventing these specific risks, you can review information from authoritative sources like the FDA's Guide to Bed Safety. Beyond entrapment, other risks include skin bruising, cuts, and agitation. The rail may also be seen as a barrier, leading a confused person to attempt climbing over it, which can result in a serious fall.

Alternatives to Bed Rails

In many cases, a safer alternative may be more appropriate.

• Lowered Bed: Using a low-profile bed or setting the bed to its lowest position can significantly reduce the risk of injury from a fall.
• Floor Mats: Placing cushioned mats next to the bed can soften the impact if a fall does occur.
• Bed Alarms: Pressure-sensitive alarms can alert a caregiver when a person is attempting to get out of bed.
• Concave Mattress: Specialized mattresses with raised foam edges can help with positioning and prevent roll-outs.
• Transfer Poles: A floor-to-ceiling pole can provide a secure handhold for getting in and out of bed without the risks of a bed rail.

Conclusion

While the primary reason for using a bed rail is to enhance safety, it is a device that carries its own set of significant risks. The answer to 'what are the reasons, guidelines, and safety precautions for bed rails?' is complex. They can be a valuable tool for fall prevention and mobility when prescribed after a thorough assessment and used according to strict guidelines. However, for many individuals, particularly those with cognitive impairments, the risks of entrapment and other injuries may outweigh the benefits. Always consult with a healthcare professional to explore all options and ensure that any bed rail used is correctly installed, regularly inspected, and is the right choice for the individual's specific needs.

Frequently Asked Questions

Are bed rails covered by Medicare?

Medicare Part B may cover bed rails if they are deemed medically necessary by a doctor and are considered durable medical equipment (DME). Coverage often depends on the specific type of rail and the patient's diagnosis.

What's the difference between a bed rail and a bed handle?

A bed rail is typically longer and designed to prevent a person from rolling out of bed. A bed handle (or grab bar) is a much smaller device intended solely to provide a stable grip for assistance when getting into or out of bed.

Who should NOT use a bed rail?

Individuals with cognitive impairments like severe dementia, confusion, or delirium are often poor candidates. They may not understand the rail's purpose and attempt to climb over it, leading to a more severe fall.

How do I know if a bed rail is installed correctly?

A correctly installed rail will have no gaps large enough to fit a 12-cm (soda can size) sphere between the rail and the mattress/bed frame. It should feel sturdy and not shift or move when pulled on. Always follow the manufacturer's specific instructions.

Can bed rails be used on any bed?

No. It is critical to ensure the bed rail is compatible with the specific bed frame and mattress. Using an incompatible rail is a major cause of dangerous gaps that can lead to entrapment.

What are the '7 Zones of Entrapment'?

These are seven specific locations identified by the FDA where a person's head, neck, or body can be caught: within the rail, under the rail, between the rail and mattress, and at the ends of the rail near the headboard or footboard.

Do bed rails increase agitation in people with dementia?

Yes, for some individuals, they can. The rail can be perceived as a restraint, leading to increased confusion, agitation, anxiety, and a feeling of being trapped, which can worsen behavioral symptoms.

How often should I inspect a bed rail?

A quick visual inspection for stability and positioning should be done daily. A more thorough check of all hardware and fittings, as recommended by the manufacturer, should be performed on a regular basis, such as weekly or monthly.