When Should Bed Rails Be Considered? A Comprehensive Guide to Safety

According to the U.S. Food and Drug Administration (FDA), bed rails can be used to increase patient safety but are also associated with serious risks, including entrapment and falls. Deciding when should bed rails be considered requires a careful, individualized assessment of a person's needs, mobility, and cognitive state to ensure their benefits outweigh the significant dangers involved.

Quick Summary

An individualized risk assessment is crucial before deciding on bed rail use for seniors or patients with mobility issues. Alternatives and potential dangers, such as entrapment and injury, must be evaluated to ensure proper safety and mobility while avoiding restraint-like conditions.

Key Points

• Individualized Assessment is Paramount: Before considering bed rails, a person's individual medical and mental condition must be thoroughly assessed by a healthcare professional.

• Risks Must Be Weighed Against Benefits: The potential dangers of bed rails, such as entrapment and falls from climbing over them, must be carefully balanced against the intended benefits.

• Explore All Alternatives First: Non-rail options like low beds, floor mats, increased supervision, and positional supports should be considered and documented before resorting to bed rails.

• Consent is Required: In most care settings, the use of bed rails requires informed consent from the patient or their legal decision-maker.

• Monitor and Reassess Regularly: The need for and continued use of bed rails should be regularly reviewed to ensure they remain appropriate and do not become a de facto restraint.

• Not a Standard Fall Prevention Method: Bed rails are not a routine part of a fall prevention program, and their misuse can increase injury risk.

• Consider the Psychological Impact: For individuals with dementia or confusion, bed rails can cause anxiety and increase agitation rather than providing a sense of safety.

Evaluating the Need for Bed Rails

Bed rails are a complex safety tool, not a simple solution for fall prevention. While they can offer stability and reassurance for some, they can pose significant risks for others, particularly those with cognitive impairment or mobility challenges. A comprehensive evaluation of the individual’s physical and mental condition is the first and most crucial step.

Medical and Behavioral Considerations

A person's medical history and current behavior are key indicators for assessing the appropriateness of bed rails. An assessment must involve a healthcare team and consider various factors.

• Medical Diagnosis: Conditions like dementia, delirium, and involuntary body movements can increase the risk associated with bed rails.
• Cognitive State: For individuals who are confused, agitated, or have memory issues, bed rails can increase the risk of injury as they may try to climb over them, leading to a fall from a greater height.
• Mobility: Can the person voluntarily get in and out of bed? If not, a bed rail that prevents them from doing so is a restraint. For those who need a handhold for stability, a proper assist rail might be more suitable than a full-length rail meant to contain.
• Habits and Preferences: The individual's sleep habits and preferences are important. Some people feel more secure with rails, while others feel confined and anxious.

Alternatives to Bed Rails

Before implementing bed rails, especially in a care facility, alternatives should be explored and documented. The following list provides examples of safer strategies:

• Lowering the Bed: Using a low-height or floorline bed can significantly reduce the risk of injury if a fall occurs.
• Increased Supervision: Increasing caregiver presence or moving the bed to a high-visibility area can help mitigate fall risks.
• Positional Aids: Using positional wedges or special mattresses with raised foam edges can help prevent rolling out of bed without creating an entrapment risk.
• Bedside Mats: Placing fall mats next to the bed can cushion the impact of a fall.
• Bedside Assistance: Providing a safe, sturdy handhold or bed steps with rails can offer mobility assistance without the confinement of a full-length rail.

Benefits and Risks: A Comparison

Carefully weighing the potential benefits against the significant risks is essential when deciding to use bed rails. The table below outlines a comparison of these factors.

Feature	Potential Benefits	Potential Risks
Mobility	Provides a sturdy handhold for repositioning, turning, or getting out of bed.	Can impede mobility, especially if used as a restraint against a person's will.
Fall Prevention	Can prevent inadvertent rolling out of bed for sedated or unconscious individuals.	Can cause falls from a greater height if a confused person tries to climb over the rails.
Safety	Offers a sense of security and stability for some individuals.	Increases risk of entrapment, where a person gets caught between the rails, mattress, or bed frame, potentially leading to suffocation or serious injury.
Caregiver Access	Fold-down rails can make it easier for caregivers to assist the individual.	Improper installation or use can create hazardous gaps.
Psychological Impact	Provides a feeling of safety for those afraid of falling.	Can lead to increased agitation, anxiety, and a feeling of confinement, especially for individuals with dementia.

The Legal and Ethical Landscape

In healthcare settings, the use of bed rails is heavily regulated and often requires a physician's order and informed consent. They are not considered a standard fall prevention measure and can be classified as a physical restraint if they limit a person's voluntary movement. Consent from the patient or their substitute decision-maker is often required, particularly in assisted living or nursing home environments. Regular reassessment of the need for bed rails is crucial, and documentation of the risks and benefits is mandatory.

Conclusion

Deciding when bed rails should be considered is a multi-faceted process that goes far beyond a simple desire to prevent falls. It requires a thorough, individualized assessment, careful consideration of less restrictive alternatives, and an understanding of the potential physical and psychological risks. For individuals with impaired cognition or limited mobility, the dangers of entrapment and serious falls often outweigh the benefits. In such cases, safer options like low beds, sensor pads, and increased supervision are often preferred. Ultimately, the goal is to create a safe and dignified environment that supports independence while minimizing harm. This approach involves ongoing monitoring, clear communication with the individual and their family, and a commitment to using the least restrictive methods possible. For more information, the FDA provides specific guidance on bed rail safety in healthcare settings.

Frequently Asked Questions

Are bed rails considered a form of restraint?

Yes, bed rails are often considered a physical restraint if they prevent a person from voluntarily getting out of bed or are used to restrict their freedom of movement. This is especially true when all four rails are raised. They are not considered a restraint if the person can operate the rails themselves or if partial rails allow for free exit.

What are the biggest dangers of using bed rails for older adults?

The biggest dangers include entrapment, where a person's head, neck, or body gets caught in a gap, and falls. Confused or agitated individuals may attempt to climb over the rails, leading to a fall from a greater height that causes more severe injuries.

Who should not use bed rails?

Bed rails are generally not recommended for individuals with confusion, agitation, or dementia who may attempt to climb over them. They are also risky for those with communication problems, small body mass, or impaired mobility who may not be able to free themselves if they become entrapped.

What are the alternatives to bed rails for fall prevention?

Alternatives include using a low bed or floorline bed, placing floor mats next to the bed, increasing supervision, and using positional wedges or cushions to prevent rolling. Bedside commodes and toileting assistance can also reduce the need to get out of bed independently.

When can bed rails be beneficial?

Bed rails can be beneficial for providing a handhold for a mobile person who needs assistance repositioning or getting in and out of bed. They may also be appropriate for a sedated or unconscious patient to prevent them from inadvertently rolling out of bed, but this should be based on a medical assessment.

Do I need a doctor's order to use bed rails?

In many care settings, such as nursing homes and hospitals, a doctor's order is required to use bed rails, especially if they are used as a restraint. For home use, it is still highly recommended to consult a healthcare professional to ensure they are appropriate and to receive proper guidance.

How can I ensure safe use of bed rails if they are necessary?

To ensure safety, use appropriately sized rails that fit snugly with the mattress and bed frame to eliminate entrapment gaps. Always follow manufacturer instructions for installation. Monitor the individual frequently, and position personal items like call bells within easy reach to prevent them from trying to climb out.