Despite long standing warnings from the FDA, bed rail entrapment continues to be a real threat to the safety of people in nursing homes, hospitals, and long-term care facilities. After FDA warnings were issued on rail safety, many manufacturers began production of safer designs. Although the warnings have been issued, the FDA has not imposed any bed rail recalls on beds known to commonly be the source of injury and death. The lack of formal action by the FDA will likely result in future incidents involving: injury, fractured bones, strangulation, asphyxiation and death.
The safer rail designs have yet to make there way to the places they are needed. At many facilities there is little incentive to discard a usable bed, despite the fact that the design may be antiquated and unsafe. Further, many beds are rented from medical supply companies that have a substantial inventory of beds with older designs.
Rental beds are typically the least safe beds in use today. Many rental companies pay little attention to the combination of parts used when distributing beds for home and facility use. It is common to see a mattress designed for one bed used with the frame from a different manufacturer. The combination of mattresses and bed frames results in unintended ‘gaps’ in which a person can easily get caught.
In 1985 the FDA issued a Safety Alert on the dangers of entrapment in bed rails, and other parts of hospital and nursing home beds. The alert was directed to home healthcare agencies, hospices, and nursing homes. The FDA based the alert on its published reports documenting deaths and injuries associated with beds and bed rails.
By 1999, bed safety had become such an important issue, the Hospital Bed Safety Workgroup (HBSW) was assembled by the FDA, the medical bed industry, national healthcare organizations, patient advocacy groups and other federal agencies. After years of debate, the HBSW produced a brochure, which provides guidance for selecting a bed and instructions on how to measure for dangerous gaps between the mattress and bed rails.
Lightweight patients are generally at the greatest risk for bed rail entrapment. Smaller people are more likely to fall into gaps between the mattress and the bed frame. Other factors in determining a persons susceptibility of bed rail injury are: their mobility, agitation and temporary or chronic reduced mental capacity. Patients with the above conditions require ongoing monitoring from the staff in order to reduce their risk of harm.
In order to minimize the risk of bed rail injury you should examine the bed and mattress to make sure the mattress ‘fits’ with the frame. If you see gaps between the frame and the mattress, you should point out the situation to the facility. Lastly, ask questions. Do not be afraid to ask the nursing home or long-term care facility about the type of beds they use and if they have had any problems with the bed before.
For additional information on bed rail safety, review Professor William Hyman’s article appearing on McKnight’s website here.