Problems Associated with Bed Rails in the Institutional Setting

The use of bed or side rails can present significant problems in an institutional setting. One of the most significant of these is entrapment. Entrapment happens when a patient somehow becomes stuck between the rail and the bed or within the rail itself. The Joint Commission has published detailed information about this problem and the patients most likely to be affected.

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A significant problem involved with the use of bed or side rails in any institutional or home-care setting is the risk of entrapment. Entrapment happens when t he patient falls into a gap or space in the side rails, or between the rails and the bed. When this happens, the patient may be strangled, suffocated, or receive compression-type injuries to the neck or chest. There also is significant emotional trauma that may happen from such an incident.

These entrapments happen when a patient somehow - and the reason may be unclear if someone is not supervising the patient when this occurs - becomes stuck between the mattress and the rail, within the rail itself, or in a gap that is created when the bed is articulated or adjusted. These incidents may be more common in beds where the rails or mattress do not fit the rest of the bed frame, in articulated beds (those that can be adjusted) when the rails do not adjust with the bed, and in beds without adequate fillers to present such a hazard. Entrapments also may happen when the patient becomes trapped in bedding and falls into the rail, or when a patient tries to get out of bed unassisted and falls.

The Joint Commission in a 2002 report identified several key causes at the facility for entrapment. Those causes include a breakdown in communication, improper installation, and improper monitoring on the part of facility staff.

Typical entrapments (those that occur most frequently in the nursing home setting) may cause death or serious bed rail injury. This may result from neck or chest compressions - what happens when the patient becomes stuck and has severe amounts of pressure on the neck or chest - or from asphyxiation. Positional asphyxiation happens when the patient's neck becomes stuck in a certain position and the patient is unable to breathe.

Entrapments typically are not the fault of the patient. Entrapments are more common when the patient is disoriented, elderly, or has a physical or mental difficulty. Unfortunately, the patients for whom entrapment is more likely also tend to be the patients for whom hospital and nursing home protocol require that side rails or other restraints be used.

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According to The Joint Commission, the health care agency that accredits many hospitals and nursing homes, seven deaths or serious injuries related to entrapment were reported between 1995 and 2002. Five of these nursing home deaths and injuries involved patients who were older than 65 years old. Four of those deaths were in patients with a significant mental or behavioral disability, three of the individuals were at risk for falling, and two had limited mobility. As indicated by the overlap in the number of conditions and the number of patients, several of these patients had several conditions that made them a higher risk for entrapment.

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