Bed Rail Injuries in Nursing Homes

Bed rails are commonly used in nursing homes to assist residents with mobility, prevent falls, and provide support while in bed. While bed rails can be beneficial, they also pose risks of injury if not used properly or if residents become trapped or entangled.

Bed rails are metal or plastic barriers attached to the sides of beds to help residents move safely in and out of bed, provide support while sleeping or sitting up, and prevent falls. Bed rails can be adjustable or fixed and may include side rails, half rails, or full-length rails, depending on the resident’s needs and preferences.

Understanding the potential risks and implementing appropriate safety measures is essential for preventing bed rail injuries in nursing home settings.

Risks and Challenges Associated with Bed Rails

The U.S. Consumer Product Safety Commission (CPSC) cautions that there is an unreasonable risk of injury and death by entrapment and other hazards from adult portable bed rails, with 284 fatal incidents between January 2003 and December 2021.

The use of permanent or portable bed rails in nursing homes, while intended to enhance resident safety, can also pose various risks of injury if not managed properly.

These risks include:

• Entrapment: One of the most significant risks associated with bed rails is entrapment, where residents become trapped or wedged between the bed rail and the mattress, bed frame, or other parts of the bed. Entrapment can lead to serious injuries, including suffocation, strangulation, or fractures, and may be fatal in some cases.
• Strangulation and Asphyxiation: Residents may be at risk of strangulation or asphyxiation if they become trapped or entangled in the bed rail, bedding, or other objects within the bed. Strangulation hazards can occur if residents slide down in bed and their neck or head becomes caught between the bed rail and the mattress. or if they become tangled in bed rails or bedding while attempting to reposition themselves.
• Soft Tissue Injuries: Residents may experience soft tissue injuries, such as bruising, abrasions, or lacerations, if they come into contact with bed rails or attempt to climb over them. Soft tissue injuries can result from friction or pressure between the resident’s skin and the bed rail or from impact injuries caused by falling against the bed rail.
• Fractures and Traumatic Injuries: In more severe cases, residents may sustain fractures or traumatic injuries if they fall from the bed while attempting to climb over or around the bed rail. Fractures may occur in the arms, legs, hips, or spine, depending on the nature and force of the fall, and may require medical attention, rehabilitation, or surgery.
• Restraint-related Risks: Inappropriate or excessive use of bed rails as restraints can increase the risk of falls and injuries by limiting residents’ mobility and ability to reposition themselves independently. Restricting residents’ movement with bed rails can also contribute to feelings of frustration, agitation, or loss of dignity and may negatively impact their overall well-being.
• Skin Damage: Improperly installed or poorly maintained bed rails may cause skin damage, such as pressure ulcers or abrasions if they rub against the resident’s skin or create friction during movement. Residents with fragile or sensitive skin may be particularly susceptible to skin damage from bed rail-related injuries.
• Psychological Impact: Fear or anxiety related to bed rail use, particularly among residents with cognitive impairments or dementia, can have a negative psychological impact and may contribute to behavioral disturbances, agitation, or social withdrawal. The S. Food & Drug Administration (FDA) states that “people who are cognitively impaired from the use of medication or from a medical condition, such as Alzheimer’s or dementia, Parkinson’s disease, Multiple Sclerosis (MS), balance disorders, stroke, or low blood pressure (hypotension), are at a higher risk of entrapment and injury.” Residents may feel confused, disoriented, or frightened by the presence of bed rails, especially if they perceive them as confining or restrictive.

Overall, while bed rails can provide support and safety for residents in nursing homes, it is essential to recognize and address the potential risks associated with their use to ensure resident safety and well-being.

Implementing appropriate safety measures, conducting regular risk assessments, and providing staff education and training on bed rail safety are critical steps in mitigating these risks and promoting a culture of safety within nursing home settings.

Preventing Bed rail Injuries

Preventing bed rail injuries in nursing homes requires a multifaceted approach focusing on resident safety, staff training, and regulatory compliance. Some key strategies for preventing bed rail injuries include:

Resident Assessment and Monitoring

Conducting comprehensive assessments of residents’ mobility, cognitive function, and risk factors for falls and injuries can help identify individuals who may benefit from bed rail use and those at increased risk of harm. Regular monitoring and reassessment of residents’ needs and conditions are essential for ensuring that bed rails are used safely and appropriately.

Proper Installation and Maintenance

Ensuring that bed rails are installed correctly, securely attached to the bed frame, and in good working condition is essential for preventing accidents and injuries. Staff should receive training on proper bed rail installation, inspection, and maintenance procedures. They should regularly inspect bed rails for signs of damage, wear, or malfunction.

Staff Education and Training

Providing comprehensive education and training programs for nursing home staff on bed rail safety, risk assessment, and injury prevention strategies can help promote a culture of safety and awareness within the facility. Staff should be trained to recognize the signs of bed rail injuries, respond appropriately to resident needs and concerns, and implement preventive measures to reduce the risk of accidents and injuries.

Regulatory Compliance and Quality Improvement

Compliance with state and federal regulations governing bed rail use and safety in nursing homes is essential for protecting residents and minimizing the risk of injuries. Nursing homes should adhere to regulatory standards and guidelines for bed rail design, installation, use, and monitoring and should implement quality improvement initiatives to identify and address potential safety concerns or deficiencies.

Bed rails play a valuable role in promoting resident safety and mobility in nursing homes, but they also pose risks for injury if not used properly or if residents become trapped or entangled.

By understanding the potential risks, implementing appropriate safety measures, and promoting a culture of safety and awareness within the facility, nursing homes can help prevent bed rail injuries and ensure the well-being of their residents.