Risk management for healthcare entities: Safe use of patient bed rails

Healthcare entities have an ethical and legal obligation to provide safe and quality healthcare services to all patients under their care. Part of this responsibility is ensuring healthcare professionals know how to safely and appropriately use the equipment necessary to provide care in their role.

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A critical piece of equipment in many healthcare settings is the bed where a patient stays and its accompanying safety rails. Patient bed rails play a crucial role in enhancing patient safety and preventing unintentional accidents or injuries. By providing a supportive structure, bed rails help patients maintain balance and stability while in bed, limit excessive movement that may lead to falls or other injuries, aid in safe transfers to and from the bed, and support patients in feeling secure.

While patient bed rails benefit patients, healthcare entities must also consider the range of risks that exist if bed rails are not used safely and address them with a comprehensive risk management plan. This plan should outline the policies, procedures, training, and maintenance necessary to ensure that healthcare practitioners and staff are using bed rails appropriately and delivering the safest, highest quality care.

The following guidance highlights key risk controls healthcare entities may implement around safe usage of patient bed rails. It is not an exhaustive list and should be used in conjunction with internal policies and procedures and professional standards, as well as in compliance with local laws and regulations.

Code of conduct

Establishing an extensive code of conduct is essential for aligning your organization on best practices. The code of conduct should clearly communicate the position of the healthcare entity on the importance of the safe usage of bed rails, while providing guidance on the sourcing, training, usage, and maintenance of patient bed rails for patients under its care.

Develop and review, at least annually, a suite of policies and procedures that addresses the following:
- Commitment to upholding the safe and effective use of patient bed rails
- Establishment of where policies and procedures are enforced
- Expected accountability of all relevant parties, including:
  - Employees (For example, nursing and allied health)
  - Independent practitioners (For example, physicians and midwives)
  - Students
- Safe and appropriate use of patient bed rails
- Unsafe and inappropriate use of patient bed rails
- Clinical and non-clinical considerations for using patient bed rails
Ensure policy trainings are provided to all individuals and groups
Ensure policies and procedures are easily accessible to all individuals and groups

Sourcing

It is essential that healthcare entities source patient beds and bed rails from reputable manufacturers who can provide important information regarding their construction and quality. Healthcare entities should consider adopting the following sourcing practices for patient beds and bed rails:

Confirm the following information with the bed and bed rail manufacturers:
- Product meets all relevant safety standards
- Product warranty
- Product durability
- Equipment materials, including paints and finishes
- Maintenance schedules
- Repair and replacement processes
Avoid purchasing equipment that has been discarded or donated by a third-party
Perform a thorough inspection of patient beds and rails after assembly and prior to first use

Training

Every healthcare professional working with patient beds and bed rails, including employees, independent practitioners, and students, should participate in training around safe and responsible equipment usage. All training development, review, and updates should meet organizational, professional, and ethical standards.

Develop a role-based training program that enhances awareness and understanding around the safe operation of patient beds and bed rails. Specifically, the training should address the following:
- Safe use of patient bed rails
- Unsafe use of patient bed rails
- Patient considerations for using patient bed rails, including:
  - Benefits of patient bed rail use
  - Risks associated with patient bed rail use
  - Assessment of patient bed rail entrapment
- Consequences of non-compliance with policies and procedures
- Proper procedures for reporting and responding to a patient safety incident
Establish a regular training schedule, which require employees, independent practitioners, and students to receive training upon hire as well as frequent refresher trainings

Best practices for using patient bed rails

All employees, independent practitioners, and students working with patient beds and bed rails need to exercise their due diligence to maintain the safety of patients across all settings. The following considerations are critical:

Patient considerations

Review proper use of patient bed rails with the patient and healthcare team, highlighting the following:
- Benefits of patient bed rail use, including:
- Reduction in the risk of patient falls and injury
- Aid with patient turning and repositioning
- Stable handles for getting in or out of bed
- Perception of comfort and security
Risks of patient bed rail use, including:
- Falls due to patient climbing over bed rails
- Strangling, suffocating, and bodily injury due to body parts are caught within bed rails
- Skin bruising, cuts, and scrapes
- Feelings of agitation and frustration
- Feelings of isolation and restriction
- Inability to perform daily activities
Document use of patient bed rails within the patient care plan

Safe use

Adopt the following measures for the safe use of patient bed rails::
- Check patient bed rails for risk of falls and entrapment at regular intervals, including:
  - Start/end of work shift
  - Entry/return to bed
  - During rounding
Utilize one or more sections of patient bed rails on each bed
- Place bed in its lowest height position with wheels locked
- Anticipate instances that may result in patient needing or wanting to get out of the bed, such as:
  - Going to the bathroom
  - Confusion
  - Pain
  - Restlessness
- Utilize a mattress that appropriately fits the bed
- Encourage patient to use call bell or intercom when assistance is required

Unsafe use

Patient bed rails should not be used if:
- It is against the patient’s wishes
- It is used as a physical restraint
- It is used to restrict the patient from independently performing daily activities
- There may be other instances when using patient bed rails can be unsafe. Please refer to the safety policies and procedures for more details.

Inspection and maintenance

Healthcare entities need to establish a thorough maintenance program that outlines proper protocols for regular inspections of patient beds and bed rails, as well as how to dispatch any damages requiring repairs or replacement. This program should include mechanisms on how to conduct inspections and how to report the findings. When developing the maintenance program for your facility, the following actions should be considered:

Inspection
- Establish an inspection policy, which should outline the required frequency of inspections and activities needed to repair, remove, and reinstate damaged or defective patient beds and bed rails
- Conduct regular inspections of patient beds and bed rails to verify that everything is in safe, working condition:
  - Check all patient beds and bed rails for excessive wear and tear
  - Repair or remove any damaged or defective patient beds and bed rails
  - Place a clearly identifiable tag if patient beds and bed rails are unavailable for use and/or under repair
Test all patient beds and bed rails prior to making them available for use with patients
- Maintenance
  - Dispatch any identified damages that need to be repaired or replaced
  - Inspect any work previously dispatched to be repaired or replaced prior to use
  - Log all inspections and findings as outlined in the program

Summary

As part of delivering safe and quality services, healthcare entities must take the appropriate measures to ensure professionals know how to appropriately use patient beds and rails. A comprehensive risk management program can help align organizations on the policies, procedures, training, and maintenance necessary to maintain proper usage of patient bed rails and uphold a high standard of care.

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