The use of bed rails is often overlooked as a safety measure in nursing homes. One of my first cases as a legal nurse consultant was a fall case in a nursing home. In this case, the bed rails were being used on the bed. The elderly woman had suffered a cerebrovascular accident (stroke) and a fall at her home. At admission to the nursing home, the woman (resident) was confused, and her ability to move purposefully was impaired. Unfortunately, though bed rails were being used, the nursing staff left the bed rails down (not engaged) and the level of the bed raised from the floor. The resident rolled out of bed. She sustained injuries from the fall that lead to her death. This preventable incident was a result of the lack of use of the bed rails and leaving the level of the bed raised to an unsafe height.
Understanding the Importance of Bed Rails
As one ages, the body becomes more fragile and susceptible to injuries, and falls pose a significant risk. In fact, falls are one of the leading causes of injuries among the elderly. To mitigate this risk, it is crucial to proactively address fall prevention, and the appropriate use of bed rails can play a pivotal role in achieving this objective.
Bed rails act as physical barriers, preventing accidental rolling out of bed during sleep. They can provide seniors with support and stability when getting in and out of bed, reducing the likelihood of imbalance and falls. By installing bed rails, individuals can experience a heightened sense of security and confidence, enabling them to navigate their daily routines with greater ease.
Key Benefits of Bed Rails
Enhanced Safety
Bed rails can significantly enhance safety. Acting as protective boundaries, they reduce the risk of falls and subsequent injuries. By establishing a secure perimeter around the bed, bedrails can provide a sense of reassurance.
Improved Independence
Bed rails can empower and promote independence. A sturdy handrail can enable transfer in and out of bed, reducing the likelihood of imbalance, falls, and minimize reliance on others. This increased autonomy contributes to the overall well-being and preserves the dignity of the elderly patient.
Optimal Comfort and Rest
A good night’s sleep is essential for maintaining health and well-being. Bed rails contribute to improved comfort and quality of rest. By knowing there is a reliable support system in place, the patient can sleep soundly, free from worry about accidental falls. This sense of security fosters a more restful and rejuvenating sleep experience.
Assisted Mobility
Bed rails offer valuable assistance in terms of mobility. They provide a stable grip that enables the elderly patient to reposition comfortably in bed, change the sleeping posture, or sit up without the fear of losing balance. This additional support is particularly advantageous for those with limited mobility or conditions such as arthritis.
Peace of Mind for Caregivers
For those caring for the elderly at home, the use of bedrails can provide peace of mind. Knowing that their loved ones are safeguarded from potential falls alleviates stress and allows caregivers to focus on other aspects of caregiving. Bed rails can create a safer environment that contributes to a more relaxed caregiving experience.
Risks Associated with Use of Bed Rails
While there are many benefits to using bed rails, it is important to also be aware of the dangers associated with their misuse.
Bed rails can help prevent falls and reduce the potential risks of both fatal and nonfatal injury by securing the mattress at the bottom edge. However, there are also dangers associated with their misuse. Federal guidelines for bed rails require that facilities attempt to use appropriate alternatives prior to installing a side or bed rail. If a bed or side rail is used, the facility must ensure correct installation, use, and maintenance of bed rails.
According to federal guidelines, before installing a bed rail, the facility must assess the resident for risk of entrapment and review the risks and benefits of bed rails with the resident or resident representative. Informed consent must be obtained prior to installation. The facility must also ensure that the bed’s dimensions are appropriate for the resident’s size and weight and follow the manufacturers’ recommendations and specifications for installing and maintaining bed rails.
Restraint or Mobility Aid
Bed rails are considered a restraint when they are used to intentionally prevent a person from getting in and out of bed. The Omnibus Budget Reconciliation Act (OBRA) was passed in 1987 to address concerns about conditions in long-term care facilities. The Nursing Home Quality Reform Act (NHRA) was included in the OBRA legislation to standardize assessment, care, and treatment of the elderly in facilities receiving federal funding. Also included in the NHRA was a statement related to a resident’s right of freedom and autonomy. Routine use of restraints was a common practice in 1987 and led to increased immobility and deconditioning among residents. Consequently, institutions were mandated to reduce the use of restraints within facilities.
Bed Rail Evaluation and Consent
Prior to the use of bed rails, an evaluation should be done. Evaluation is done to assess the need and purpose of the bed rail. Questions asked are (1) does the patient need bed rails for positioning/support and/or rising from lying to sitting and or to assist to a standing position as a mobility enabler (2) do the bed rails restrain the patient’s movement, and (3) are the bed rails a preference of the patient or the representative?
After the evaluation, consent for bed rail use must be obtained. The clinical record must show evidence of the resident’s or his/her representative’s informed consent for use of bed rails. It must also show the selected purpose for the consent for use of bed rails.
Additional Tips for Fall Prevention
While bed rails are a valuable tool in fall prevention, it’s important to adopt a holistic approach to ensure overall safety. Here are some additional tips to complement the use of bedrails:
Proper Lighting
Ensure that the bedroom has adequate lighting, particularly during nighttime. If in the home, consider installing nightlights or motion sensor lights to illuminate the path from the bed to the bathroom or other frequently accessed areas. Well-lit surroundings help to navigate safely, reducing the risk of tripping or falling.
Clear Pathways
Keep the area around the bed clear of any clutter or obstacles. Ensure that pathways are unobstructed, allowing the patient or family member to move around without hindrance. Removing potential tripping hazards minimizes the risk of falls and promotes a safer environment.
Non-Slip Flooring
The use of non-slip floor stripping near the bed, especially if the floor surface is smooth or slippery. These strips provide additional traction and stability, reducing the likelihood of slips or falls when getting in and out of bed.
Non-Slip footwear
Non-slip footwear provides better traction and stability on slippery surfaces. They are designed with a non-slip grip on the sole, which helps to reduce the risk of slipping and falling. Typically, the non-slip socks are double-sided with the non-slip grip sole resting on the top and bottom of the feet. It important to ensure that the socks are correctly sized for the patient.
Medication Management
Some medications have side effects that impact balance or stability. Additionally, some may alter the level of awareness and alertness. It is important for the clinical staff and caregivers to be aware of the potential side effects and monitor for the side effects that may cause a fall.
Conclusion
The use of bed rails is but one possible consideration for use in promoting safety and preventing falls. There are many other interventions to consider. The scope of fall prevention in the elderly exceeds this writing, but some interventions to consider are: (1) adjustable height beds, (2) bed wedges, (3) bumpers and bolsters, (4) concave mattress, (5) fall mats or crash mats, and (6) motion sensor alarms. Each of these has its own advantages and disadvantages, so it is important for the clinical staff to consider the specific needs and preferences when deciding on an appropriate bed safety solution.
When bed rails are used, it is important for facilities to carefully assess each resident’s needs and follow federal guidelines to ensure their safe use. As we prioritize the safety and comfort of our aging population and those in facilities, incorporating the safe use of bed rails and adopting preventive measures will enable senior adults to maintain their independence and enjoy a higher quality of life.
Regardless of the intervention employed to prevent falls, routine observation and supervision of the patient should be done. Depending on the assessment of the patient, observation and supervision may require scheduled rounding.