Bed rails, side rails or cot sides are commonly used equipment in healthcare. They are intended to prevent individuals from accidently failing out of the bed, something which can potentially cause huge amounts of distress, injury, even death. Reports in 2007 show that in England and Wales in one year alone, 44,000 people suffered bed falls while in hospital. Of these 90 sustained a fractured neck of femur and 11 died. In addition, these devices can not only safety but a sense of security among those at risk of falls.
However bed rails can pose a risk to health and safety.
In 2001 the Medical Devices Agency, later known as the Medicines and Healthcare products Regulatory Agency, or MHRA, raised concerns over the problems of using bedrails in clinical practice and issued guidance for their safe use. This was later amended in 2006 when its document Safe Use of Bed Rails DB 2006(06) was published. This sets out the role of bedrails, the areas of concern in bedrail use, the importance of regular inspection, maintenance and training.
The Health and Safety Executive or HSE works closely with specialist groups such as the MHRA to ensure that safety is paramount within the workplace. In the case of bedrails, the HSE published guidance for Local Authority Health and Safety Enforcement Managers in 2007 (Bed Rail risk management SIM 07/2007/06) following the publication of the MHRA guidelines.
This document outlined the risks involved in the use of bedrails in the clinical environment and highlighted where individuals could be at risk unless certain assessments and corrective actions were undertaken. The document instructed inspectors how failure to comply with the guidance could put care managers and owners in breach of health and safety legislation. Armed with this guidance, organizations such as the Care Quality Commission (CQC) and local authority inspectors have the tools to ensure compliance with the recommended guidelines and the powers in law to ensure safe practice. Failure to adequately protect service users can result in the HSE issuing improvement notices (or even closure notices) and could lead to criminal proceedings.
The key components of the guidance regard the need to assess the suitability and needs of clients before fitting bedrails, the importance of regular maintenance, the need to fit bed rails or side rails correctly, the need to undertake staff training and the need to maintain clear, accurate and timely documentation of all bedrail-related issues. A substantial amount of the regulations relates to what the National Patient Safety Agency refers to as “mind the gap”.
Bed rails or cot sides are also responsible for a huge amount of deaths and injuries each year due to an issue called bed rail entrapment. This dreadful and quite avoidable situation occurs due to a combination of issues. These normally include using the incorrect bed rails in relation to the bed and / or not maintaining the bed rails correctly. Other causes of bed rail entrapment are the use of outdated nursing or hospital beds produced prior to the safety standards Ben1970 and or IEC60601-2-38. The use of such outdated or unmanaged equipment, which are by their very design complex class 1 medical devices, often leaves the care provider without insurance cover and open to substantial litigation.
Bedrails, cotsides or side rails need to be fitted in such a way as to prevent cot side entrapment by carers and users. There are specific dimensions given for the spaces allowed between bars and between the bars and various parts of the bed frame and headboard. A key issue for many care givers is in relation to the required height of bed rails above the support surface. To prevent users from falling over the upper most bed rail, and causing major injury, the top of the bed rail must be at least 22 cms above the non-compressed surface of the mattress
The majority of bedrails are designed for use with a 5 inch foam mattress. This makes their use with standard full replacement air mattresses, which are normally 9 inches deep, or with an overlay air mattress or airflow mattress potentially in breach of the regulations.
Using incorrectly fitted, poorly maintained or defective bedrails places clients at risk and could result in care staff and nursing home owners liable to prosecution under Health and Safety regulations. This includes the use of bed rails or cot sides that are too low to safely prevent client bed falls.
Bed Rail or cot side extensions are available for retrospective fitting to some beds but these have issues and can pose serious risks for both clients and healthcare workers. The higher the side rail extension from the floor – the further a patient can fall from bed. Anyone who has seen the results of a bed fall to an elderly fragile patient will understand the implications of their use.
Why is “low profile so important?
Bedrails should be used to prevent bed occupants’ from falling and sustaining injury and are not intended as a form of restraint.
The Health & Safety Executive (HSE) is set up by statute and is charged with preventing death, injury and ill health to those at work and those affected by work activities. Failure to comply with their recommendations, guidance and regulations can be deemed as breech of statute and is punishable under criminal law. The HSE website ( www.hse.gov.uk ) publishes actions taken by the authority against institutions including details of fines and legal sanctions. In 2006/ 2007 the HSE reported that a total of 979 accidents occurred in care homes and hospices, with 27 fatalities attributable to bedrails. Because of the high risk of injury posed by bedrails, specific guidance has been issued by the HSE. For further details see MHRA Safe use of Bedrails DB2006(06) Among the many recommendations made, the HSE states that where bed rails are required, the distance between the top of the support surface (mattress) and the top of the bed side rail should be in excess of 22cm. The Squirrel Diamond™ (Patented) has been designed to fit most modern nursing beds.
Patient stability
Deep cell air mattresses have been used for many years to successfully prevent pressure ulcer development however this is not problem-free. One significant issue has been the instability patients experience when sitting on the edge of an air-filled surface of 23cms (9”). Patient stability is an important factor when patients are undergoing physiotherapy, rehabilitation or simply when rising from the bed.
Squirrel Medical strongly advocates the use of suitable 5″ depth high stability air mattresses to help reduce the instances of bed falls.
