Reducing the Risk of Entrapment at the Local Level

There are numerous practices that nursing homes can incorporate to reduce the hazard risks associated with bed and side rails. Key points for institutions to consider and remember are the proper use of gap fillers and physical correction devices, and proper communication and education of all staff and physicians who may be using side rails with patients and residents.

There are steps that facilities can take to reduce the hazard risk from bed rails, and help to prevent needless bed rail deaths and injuries that result from bed and side rail entrapments. According to a 2002 report from The Joint Commission, there are two primary causes of bed rail entrapments: communication problems and equipment "factors". Both of these causes can be remedied at the level of the facility and do not require complex intervention from the manufacturer or supplier. Even though facilities can use these methods, they often are not implemented.

Communication was the primary cause and finding found in entrapment situations. According to The Joint Commission's report, there often were breakdowns in communications between staff, physicians, and administration. Improving communication, therefore, ought to have a profound effect on reducing risk hazard and saving lives. It's important for all staff to be trained and educated in the proper use of side rails and physical corrections. Staff need to be aware of where entrapment zones are, and the corrections that should be taken to reduce those zones. Staff also should be educated about how to do a proper assessment of a patient at risk for falls and entrapment, and should receive training on how to monitor the patient for possible entrapment before the entrapment happens.

The Joint Commission noted that in four of five cases, side rail protectors were not being used. This is a failure on the part of the nursing home to use a very viable option for reducing hazard risk. This is a simple measure that, if used correctly, can safe lives and prevent bed rail injury. The Food and Drug Administration also has issued a guide to help facilities modify bed and side rails to reduce the risk of entrapment.

Gap fillers are used frequently in nursing homes to help eliminate the gap that exists within a rail or between the rail and the mattress. Gap fillers are devices that can be used specifically in the gap, and they often are designed by the manufacturer to match that gap precisely. These are not always the idea solution, however. The gap fillers can fall out from where they are positioned; they also may move from there they are placed. Wedges serve the same purpose, but may be prone to the same concerns about moving or falling out. A wedge, because of its design, may be somewhat less likely to move out of place.

Other methods also exist to help reduce the hazard that is posed by the rail on its own in isolation from the bed. Several manufacturers produce rail safety pads. These pads cover the bed or side rail while the rail is in use. This solution is less prone to movement, and allows the rails to function as needed. They may carry a risk to the patient, however, of suffocation. Suffocation can happen if the patient rolls over in bed and has the mouth and nose trapped against the pad. If the patient cannot move back away from the pad, or if personnel are unable to assist the patient in a timely manner, the patient may suffer brain damage or bed rail death due to the suffocation.

Free Bed Rail Case Review

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