Scope

  • Policy Statement

  • The Policy

  • Assessment
  • Potential Risks
  • Ensuring the Correct Use of Bed Rails
  • Examples of Bed Rail Entrapment
  • Bed Bumpers
  • Key Points to Be Considered Before the Use of Bed Rails
  • Risk of Fall When Using Bed Rails
  • Alternatives to Using Rigid Bedrails
  • Further Guidance

  • Related Policies

  • Related Guidance

  • Training Statement

Policy Statement

The use of bed rails is, from time to time, unavoidable for the health, safety, and wellbeing of our service users. Where the service user has the capacity, a full discussion takes place between the service user and the health professional, e.g. occupational therapist, and consent is obtained before bed rails are put into place.
If the service user has bedrails in place before the commencement of the service, advice is taken from an occupational Therapist. The bedrails are the responsibility of the service user or their family in this situation.

Where a service user lacks capacity, bed rails are considered a restriction or restraint as defined by the Mental Capacity Act 2005. A standard authorisation request must be made to the appropriate supervising body. Only after the authorisation is granted can bed rails be fitted and used.
This organisation follows guidelines prepared by the Department of Health, Positive and Proactive Care: Reducing the Need for Restrictive Interventions, issued in April 2014.

Rigid bed rails can be classified into two basic types:

Integral types: that are incorporated into the bed design and supplied with it or are offered as an optional accessory by the bed manufacturer, to be fitted later.
Third-party :types that are not specific to any particular model of bed. They may be intended to fit a wide range of domestic, divan or metal framed beds from different suppliers

The Policy

Assessment

The assessment must initially be carried out by a health professional who retains accountability. such as an occupational therapist. Consideration will be given as to whether bed rails are the appropriate means of managing that risk, e.g. if the individual is likely to try to climb over the rails due to confusion, then other control measures (such as extra-low beds and/or sensor alarms) will be more appropriate.

Bed rails are not intended to:

  • Limit freedom of movement.
  • Restrain people.
  • Be used as grab handles.

Every effort is made to involve the service user or their family in the decision-making process with the health professional and to explain why and how bed rails are used. Families sometimes expect bed rails to be used out of concern for the safety of their relatives, not realising the potential risks, and that their use may not be the best approach. Where bed rails are fitted, staff are made aware of the risks and how to ensure the service user’s safety. Information on whether bed rails are used is included in the service user’s care plan.

Information on whether bed rails are used is included in the resident’s care plan.

Note: People who lack capacity could be at greater risk from using bed rails, therefore an alternative such as a mattress or crash mat on the floor could be used to soften a fall; a plan must be in place as to how the individual will be raised off the mattress/mat should they fall onto it.
On completion of the risk assessment, if bed rails are indicated but the individual refuses to have them implemented then this should be documented in the individual’s care plan; an alternative measure to prevent harm to the individual should be used

  • All food should be prepared, cooked, stored, and presented following the high standards required by the Food Safety Act 1990, the Food Safety (General Food Hygiene) Regulations 1995, the Food Safety (Temperature Control) Regulations 1995, and the Food Safety & Hygiene England Regulations 2013.
  • Staff must keep all food preparation areas, storage areas, and serving areas clean while in use.
  • All tools and equipment, such as knives, utensils, and chopping boards, must be cleaned regularly during the cooking process.
  • Adequate sanitary and hand-washing facilities should be available within the kitchen, including a supply of soap and paper towels for hand drying.

  • All staff are required to wash their hands:

    • Before starting work.
    • Before putting on single service gloves.
    • After touching raw, fresh or frozen beef, poultry, fish, or meat.
    • After mopping, sweeping, removing garbage, or using the telephone,
    • After using the bathroom.
    • After smoking, eating, sneezing, or drinking.
  • Everyone in a food handling area must maintain a high level of personal cleanliness and food handlers must wear suitable, clean and wear appropriate protective clothing.
  • Staff preparing food should take all reasonable, practical steps to avoid the risk of contamination of food or ingredients.
  • Food storage areas should protect food against external sources of contamination such as pests.
  • Food handlers must receive adequate supervision, instruction and training in food hygiene.
  • When serving food, appropriate hygiene standards should be scrupulously observed by all staff.
  • Suspected outbreaks of food-related illness should be reported immediately to the service user’s GP.
  • If any member of staff handling food becomes ill, e.g. with diarrhoea or vomiting they must stop work at once and report to their line manager/supervisor; such staff should not return to work until completely free of symptoms for 48 hours.

  • If the individual has been diagnosed by a medical professional (e.g. their doctor) with a specific infection, this may require different action.

    In addition, staff should:

  • Always wash their hands after visiting the toilet.
  • Ensure that all food stored in the refrigerator is covered and adequately chilled.
  • Ensure the thorough cooking and re-heating of all meat, especially poultry.
  • Ensure that deep frozen food is thawed before cooking (especially important when using a microwave oven).
  • Be aware of the risk of salmonella infection associated with foods containing uncooked eggs such as mayonnaise and certain puddings.
  • Wash hands after handling raw meat or eggs, particularly before handling other foods.
  • Never re-use utensils with which raw eggs or meat have been prepared without first washing them with hot water and detergent.
  • Never allow juices from raw meat to come into contact with other foods (cooked food and uncooked food should not be stored together).
  • Avoid serving raw eggs (or uncooked foods made from them) to vulnerable people such as the elderly and the sick (all eggs should be cooked until they are hard, both yoke and white).

Potential Risks

The following potential risks from the use of bed rails will be considered:

  • Falling out of the end of the bed or over the top of the bed rail.
  • Entrapment between the bed rails and the mattress.
  • Entrapment between the bed rails and the head and foot of the bed.
  • Individual attempting to climb over the rails.
  • Failure of the bed rails.
  • Climbing over the footboard.
  • Violently shaking and dislodging rails.
  • Violent contact with parts of the bed rail.

Consideration is given to the individual’s strength; individuals who are weak may be unable to move their position and therefore be at risk of asphyxiation if their head or neck became draped over the rail

Ensuring the Correct Use of Bed Rails

Note: BS EN 60601-2-52:2010 came into force for all new equipment manufactured or supplied from 1 April 2013. Bed rail dimensions are found in BS EN 50637 issued in 2017 when assessing risk and ensuring correct fitting.
When using bed rails, we work with other professionals such as the occupational therapist or district nurses and the bed rail supplier to ensure the compatibility of the service user, bed, mattress, bed rail and any associated equipment. Both bed rails should be used to eliminate gaps between the bed and other furniture or wall and to help keep the mattress in position.

Some key points must be considered relating to the potential for entrapment:

  • Underneath the rail.
  • Between the end of the rail and the headboard or footboard.
  • Between the rail and the side of the mattress.
  • Between the bed-rail bars.

Examples of Bed Rail Entrapment

Entrapment underneath the rail (Figure 1)

The service user can become trapped between the bottom of the rail and the mattress if the gap beneath the rail is too large. This could be due to:

  • Incompatibility of bed rail and bed.
  • Using an airflow mattress in conjunction with a thin-base mattress.
  • Using easily compressible base mattresses or a mattress that is too small for the bed.
  • Using an airflow mattress, which may be more compressible at the edges, in conjunction with thinner or easily compressible base mattresses, could allow access to the gap under the rail.

Figure 1 Entrapment under the rail can lead to asphyxiation

British Standard BS EN 60601-2-52:2010 states that the gap from any accessible opening between the bottom of the side rail and the mattress platform should be no more than 60 mm. When assessing this gap, it should be taken into consideration whether mattresses are thin, easily compressible at the edge and whether the individual’s dimensions increase the risk of slipping underneath the rails. Mattresses should always fit snugly, with no significant gap, between both bed rails

Entrapment between the end of the rail and the headboard or footboard (Figure 2)

If the rails are not secured in a safe position, service users can become trapped between the end of the bed rail and the headboard or footboard.

Figure 2 Entrapment between the end of the bed rail and the headboard

British Standard BS EN 60601-2-52:2010 states that:

  • The gap between the end of the bed rail and headboard should be no more than 60 mm.
  • The gap between the footboard and end of the bed rail should either be 60 mm or less, or greater than 318 mm, to prevent asphyxiation.
  • Likewise, where two-section split rails are used, the gap between the two sections should be 60 mm or less, or greater than 318 mm.

Entrapment between the bed rail and the side of the mattress (Figure 3)

A poorly fitting mattress can lead to entrapment in the space between the side of the mattress and the rail. This can be caused by:

  • Poorly fitting bed rail system and/or insecure fittings that allow the bed rail to move away from the side of the bed.
  • Bed rails only being used on one side of the bed, allowing the mattress to move away from it.

Figure 3 Entrapment between the bed rail and the side of the mattress

Replacement mattresses that are narrower than the original mattress, or smaller speciality mattresses used on top of existing mattresses, may result in an excessive gap between the mattress and the bed rail. Poorly maintained bed rails may be too flexible, may deform under force or have too much play in their fixings, resulting in a gap between the mattress edge and rail.

The mattress should fit snugly between both rails so it does not allow entrapment of the occupant’s head or body. This gap must be checked, taking into account the service user using the bed rails.

Bed-rail bumpers or gap fillers can be used in conjunction with bed rails. When used(in conjunction with a correctly fitted bed rail), accessories should be robust, so they cannot accidentally be displaced or easily damaged. They conform to the British Standards and checks should be made with the bedrail supplier before use.

Bed Bumpers

  • As there is a risk of the individual trapping their head, body or limbs between the rails, specifically designed padded accessories such as bed bumpers must be properly applied. Where unavailable, this must be documented and bed rails must not be used.
  • It must be remembered that some padded accessories are not air permeable and may present a suffocation risk if the individual was to become entrapped.
  • Bed bumpers, padded accessories or enveloping covers are primarily used to prevent impact injuries, however, bumpers that can move or compress may themselves introduce entrapment risk.
  • Bed bumpers must be cleaned daily using detergent and water, preferably with disposable cloths or wipes; wipe all outer surfaces and dry thoroughly.
  • Bed bumpers must be checked for signs of damage at each clean; any sign of damage must be reported and the bumper removed.
  • The inspections must be documented and records kept.

When bed rails are in use they should be inspected for defects and security each time they are raised.
To enable staff to check for safety before use and during their use, they receive training from the occupational therapist, who then signs off their competency to carry out the necessary checks as for Level 3 specialized training.

Key Points to be Considered Before and During the Use of Bed Rails

  • Are bed rails only provided where they are the most appropriate solution to prevent falls?
  • Are staff trained in the risks and safe use of bed rails?
  • Are rails and any accessories compatible with the bed, mattress and occupant?
  • Does the mattress fit snugly between the rails?
  • Are rails correctly fitted on both sides of the bed, secure, regularly inspected and maintained?
  • Are checks completed to ensure that gaps that could cause entrapment of the neck, head, and chest are eliminated?
  • Are all relevant records reviewed and updated in particular relation to the Mental Capacity Act 2005, the DoLS authorisation must be regularly reviewed?

Bed rails should be maintained following the manufacturer’s recommendations in the instructions for use. Examples of common types of damage include:

  • Adjusters, clamps and fixings can wear, work loose, crack, deform or be missing completely, giving rise to unwanted free play which can increase important gaps.
  • Material fatigue can also occur. Bed occupants who rattle the bed rails can exacerbate this tendency.
  • Telescopic components can become loose or jammed, discouraging correct adjustment.
  • Plastic components can degrade due to age, exposure to light and some cleaning chemicals.
  • Poor transport and storage can also cause damage to components.
  • Duvets, blankets, sheets and valances may need to be removed to check these areas properly.
  • Bedrails should be cleaned weekly or more often if required.

Bed rail assemblies should be traceable, for example by using the manufacturer’s serial number, the Unique Device Identification number (when available) or labelling with an in-house number. This will assist in ensuring that every device is regularly inspected and maintained in a satisfactory condition.

Traceability also allows devices to be suitably identified should a safety issue arise, such as a manufacturer recall due to a fault.
Records should be kept of inspections, repairs and maintenance completed on bed rails.
Manufacturers should be able to advise on the expected working life of their products.

Risk of Falls When Using Bed Rails

Falls can occur if a service user climbs or rolls over the top of the rails. The height of a bed rail above the level of the compressed mattress can prevent an inadvertent fall from a bed. BS EN 60601-2-52:2010 quotes a minimum height of 220 mm, measured vertically from the top edge of an uncompressed mattress to the top of the bed rail.

Replacing a mattress with one significantly thicker than that intended by the bed manufacturer, placing one mattress on top of another, or using mattress overlays or airflow mattresses, may reduce the effectiveness of the bed rails because of the relative height of the rail is reduced. This could increase the risk of a person involuntarily rolling or falling over the top of the bed rail.
Checks are carried out with the suppliers that the bed rails are high enough to take into account any increase in mattress thickness or additional overlay.

BS EN 60601-2-52:2010 states that, where a ‘specialty’ or ‘mattress overlay’ is used and the side rail does not meet the minimum height of 220 mm above the mattress, a risk assessment should be carried out to assure equivalent safety.

Alternatives to Rigid Bed Rails

Alternatives to bed rails will be considered, such as:

  • Netting or mesh bedsides.
  • Ultra-low height beds that minimise the risk of fall injuries.
  • Positional wedges reduce movement across the bed alarm systems to alert carers that a person has moved from their normal position or wants to get out of bed.
  • Fall mats can be placed beside the bed to reduce the severity of the impact of the bed occupant does fall.

Each of these options may act to introduce different hazards even as they reduce the risk of bed fall injury or the risk from bed rails and will be managed appropriately.

Further Guidance
Our bed rail suppliers are

Northumberland Area.
Northumbria Healthcare & Primary Trust. 43 Colbourne Cl. Cramlington.
NE23 1WB. Tel: 01670 730 595

North Tyneside Area.
Oslo Close. North Shields. NE29 7SZ. Tel: 0191 643 7050

Related Policies

Accidents, Incidents and Emergencies Reporting ( RIDDOR)
Adult Safeguarding
Health and Safety
Restraint

Related Guidance

Gov.UK: Safer Use of Bedrails, March 2020:
https://www.gov.uk/guidance/bed-rails-management-and-safe-use

HSE Safe Use of Bed Rails:
www.hse.gov.uk

British Standards Institution: BS EN 60601-2-52:2010 Particular Requirements for Basic Safety and Essential Performance of Medical Beds:
http://www.hse.gov.uk/foi/internalops/sims/pub_serv/07-12-06/appendix-3.pdf

MHRA Draft Guidance: Safe Use of Bedrails, September 2019:
https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/820830/Safe_Use_of_Bed_Rails_guidance_-_draft.pdf

Training Statement

All staff, during induction, are made aware of the organisation’s policies and procedures, all of which are used for training updates. All policies and procedures are reviewed and amended where necessary, and staff are made aware of any changes. Observations are undertaken to check skills and competencies. Various methods of training are used, including one to one, online, workbook, group meetings, and individual supervisions. External courses are sourced as required.

Date Reviewed: May 2021
Person responsible for updating this policy: Carly Fortune
Next Review Date: May 2022