Safe Use of Bed Rails
Safe Use of Bed Rails
This policy on the safe use of bed rails has been written in line with Health and Safety Executive (HSE) guidance and the device guidance produced by the Medical and Health Care Product Regulatory Agency (MHRA 2013).
It identifies the procedures used by the home to assess the risks that must be managed when it is proposed that a resident requires the use of bed rails for safety reasons. The risks are assessed and managed as part of the resident’s care plan.
By implementing this policy the home aims to make a bed rail accident a “never event”.
Bed rails include bed side-rail, safety sides, and bed guards. It is acknowledged that bed rails also act as potential restraints, therefore the home’s policy is only to use them when absolutely needed to keep a vulnerable person safe in their bed.
Before using bed rails, managers will obtain the written consent of the person or, in the case of someone who has been assessed as without mental capacity to give their consent, their representatives.
The home recognises that the risks posed by bed rails result from the interaction of the occupant’s behaviour and the suitability of the appliances. It is also aware that injuries, which in a small number of cases have been fatal, are known to be caused by:
- poorly fitting or unsuitable bed rails so that parts of the body become trapped, eg between the mattress and the bedrail
- poor bed rail design, which leave too large a gap space between the rails
- movement of the bed rail away from the side of a divan mattress
- thick mattresses or mattress overlays that reduce the effective height of the bed rail so that the person can fall out over the top of the rail
- air mattresses that are too light and unbalanced to keep the bed rail assembly in position on a divan bed
- bed rails in poor condition due to a lack of maintenance.
In line with MHRA guidance, in carrying out its risk assessments and care plans the home distinguishes between bed rails that are built into the design of the bed (integral type) and those that are added on to an existing bed arrangement (third party type). It is aware that the risks to a person’s safety from, for example, entrapment, are higher for third party types of bed rail and increases its safety measures in proportion to the risks that third party types present.
Wherever possible the home will obtain a bed that enables the integral type of bed rails to be applied for anyone whose bed safety requires such an appliance; particularly vulnerable residents such as those who:
- might be confused or have communication difficulties
- suffer from dementia
- experience repetitive or involuntary movements
- have restricted or impaired mobility.
The home understands that the degree of risk is related to the condition of the resident in relation to the type of bed rail device used, The home is always prepared to seek advice from other relevant professionals such as occupational therapists and physiotherapists to establish the need for bed rails and the most suitable type of bed rail to be used for any individual service user.
Assessing the Risks Posed by Bed Rails
Managers and the staff involved use bed rails as a clinical decision only after considering other methods that would keep the person safe in bed. However, managers are also aware that under health and safety regulations, once it has been decided that bed rails are necessary, it is essential to provide them; otherwise they could be considered negligent in their duty of care.
The risks of injury increase if the bed rail is unsuitable in relation to the occupant and the type of bed and mattress, therefore, the policy is always to assess using MRHA guidance whether:
- the occupant’s head and body is small enough to pass through the bed rail bars
- the gap between the bed rail and the side of the mattress will allow the occupant’s body to pass through it, or could trap their head
- the bed rail supplier’s or manufacturer’s instructions have been fully followed
- the bed rail has been fitted correctly to the bed and is secure — different fittings may be required for different types of bed
- there any gaps present when the bed rail is fitted to the bed that potentially will allow the occupant to become trapped.
The results of the risk assessment with any management plan are always recorded and included in the person’s care plan.
Risk Management of Bed Rails
The home manager is responsible for making regular checks to ensure that any bed rails fitted remain properly adjusted and continue to be suitable for the occupant.
If there are any changes to the bed, mattress, bed rail, occupant or occupant’s condition, the risks will be routinely reassessed.
All bed rails and fittings are inspected and maintained on a planned schedule.
Although the home aims to make bed rail accidents “never events”, it recognises that there could be occasions when a resident is or might be injured by the faulty use of any bed rails applied or through defects that have arisen.
In the event of a resident being noticeably harmed (as a result of a bed rail injury) the home will report the matter to the local Safeguarding Adults Authority so that it can take appropriate action.
It will also exercise its Duty of Candour by informing and discussing any adverse event arising from bed rail use with the resident and their representatives as part of its own investigations.
The home recognises its responsibility under the Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 2013 to report any accidents resulting in injuries to the bed occupant that might result from the misuse of bed rails to:
- the Care Quality Commission under its notifications requirements
- the MHRA under its reporting of adverse incidents procedure
The home ensures that all staff responsible for selecting, fitting and checking bed rails are trained and competent to do so.
The home also ensures that staff involved in making beds and helping occupants in and out of bed, who may also have to remove and replace bed rails, receive instruction and training in the correct fitting and adjustment of the bed rails. The training is always in line with the supplier’s or manufacturer’s instructions.
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