AGING AND DISABILITY SERVICES ADMINISTRATION
2009 CRS "Dear Provider/Administrator" Letters
August 10, 2009
ADSA: CCRSS 2009-007
ENTRAPMENT IN BED RAILS
Dear Service Provider/Administrator:
Recently we have observed an increase the use of bed rails for clients in the certified community residential program. The purpose of this letter is to alert providers to the dangers of bed rail use.
Bed rails are medical devices and may be restraints. Their use always poses a potential safety risk to clients, whether full, half, or quarter rails. The best way to prevent trapping or harming clients is to implement the use of safer alternatives and not to use bed rails.
Enclosed is a copy of the brochure from the Federal Food and Drug Administration (FDA) entitled “A Guide to Bed Safety”. While the brochure uses terminology most common to long term health care settings, the principles and information it contains is applicable to bed rail use in any situation or setting.
The brochure states that between 1985 and 2008, 772 incidents of individuals caught, trapped, entangled, or strangled in beds with rails were reported to the FDA. Out of these, 460 people died and 136 had nonfatal injuries. Washington has had a number of deaths and injuries associated with bed rail use. Potential risks of bed rail use listed in the brochure include:
- Strangling, suffocating, bodily injury or death when individuals or part of their body are caught between rails or between the bed rails and mattress.
- More serious injuries from falls when individuals 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 individuals, who are able to get out of bed, from performing routine activities such as going to the bathroom or retrieving something from a closet.
The FDA brochure also identifies a number of alternatives to help a client feel and be safe in bed without rails including:
- Use of beds that can be raised and lowered close to the floor to accommodate both the client and staff;
- Keep the bed in the lowest position with wheels locked;
- When the client is at risk of, or afraid of, falling out of bed, place mats next to the bed, as long as this does not increase the risk of accident;
- Provide transfer and mobility devices to help the client in transferring in and out of bed;
- Monitor clients frequently; and
- Anticipate and plan for reasons clients may get out of bed such as hunger or thirst, going to the bathroom, restlessness and pain.
For additional copies of this brochure, visit the FDA’s website at: http://www.fda.gov/cdrh/beds/
An FDA article entitled “Hospital Bed System Dimensional and Assessment Guidance to Reduce Entrapment” is available here.
Highlights of the article:
- The FDA does not make a distinction between home and medical bed. The term “hospital bed” is used broadly and the guidance applies to all bed rails.
- The FDA has also received reports of entrapment occurring between a wall and the side of a mattress. When providers push beds against walls, some research literature has considered this analogous to physical restraint.
- Three key body parts at risk for life-threatening entrapment in a hospital bed system are the head, neck, and chest.
- Reducing the risk of entrapment involves a multi-faceted approach that includes bed design, clinical assessment and monitoring, and meeting client needs.
For each client where bed rails are being used or considered, it is always important to evaluate and assess for client safety and to recognize the risk for entrapment.
If you have any questions, you may contact Tom Farrow, RCS Field Manager at (360) 725-2405 or FarroTJ@dshs.wa.gov.
Thank you for your continuing work with clients in the community residential services and support program.
Sincerely,
Joyce Pashley Stockwell, Director
Residential Care Services
