Senior Health – Bed Rail Risks

Before you insist on bed rails or use them at home you should be aware of the risks and a little history. You likely think their use over decades is based on effectiveness or safety yet history shows use is based on convenience and a reaction to circumstances. Their use is similar to that of cribs for children. Like cribs they are meant to keep people from falling out of bed or leaving beds unattended. The problem is the risks out weight the benefits.

In the 19th century bed rails were used to restrain psychiatric patients then later used to protect people from getting out of bed and help staff maintain control of patient activities. Little has changed in the 21st century. In the 1930’s bed rails became a standard feature to keep patients safe in bed. Incidents increased where patients climbed over or through the bed rails resulting in serious injuries or death. A nursing shortage post war increased the number of patients needing assistance getting out of bed (usually for toileting) thus increasing incidents involving bed rails. Not much has changed since many falls happen when people need to get out of bed to use the toilet.

The 1950’s led to the development of the half-rail to help patients exit the bed and reduce incidents. This helped but didn’t solve the problem. They were also used to aid in turning and positioning while lying in bed. In the 1960’s and 1970’s there was an escalating nursing shortage which prompted their continued use. This included the use of other physical restraints instead of nurse observation. Basically, the same problem we have today.

In the 1980’s falls from bed became a hospital liability issue and when the routine use of bed rails became the standard of good nursing practice. This started to conflict with mobility during recuperation although they still used full length rails on the elderly to keep them immobilized. In 1985 increasing reports to the FDA of patient incidents, accidents and entrapments sparks controversy and investigation. In 1995 the FDA issues a safety alert “Entrapment Hazards with Hospital-Bed-Rails” explaining the potential risks of bed rail use. In 1999 the FDA collaborates with the healthcare industry to form the Hospital Bed Safety Workgroup (HBSW). In 2000 Centers for Medicare and Medicaid Services (CMS) issues revisions to Surveyor Guidance governing the use of restraints in hospitals and nursing facilities due to the risks.

There are many sizes and shapes on the market based on a 19th century design with a couple of exceptions. Bed rail use needs serious thought prior to being recommended or requested in any setting. Understanding their use and history will help everyone make better choices to avoid unintended consequences.

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