Products and Medical Procedures General Hospital Devices and Supplies A Guide to Bed Safety Bed Rails in Hospitals, Nursing Homes and Home Health Care: The Facts PDF Printer Version(65 KB)Bed Rail Entrapment StatisticsToday there are about 2.5 million hospital and nursing home beds in use in the United States. Between 1985 and January 1, 2009, 803 incidents of patients* caught, trapped, entangled, or strangled in beds with rails were reported to the U.S. Food and Drug Administration. Of these reports, 480 people died, 138 had a nonfatal injury, and 185 were not injured because staff intervened. Most patients were frail, elderly or confused.* In this brochure, the term patient refers to a resident of a nursing home, any individual receiving services in a home care setting, or patients in hospitals.Patient SafetyPatients who have problems with memory, sleeping, incontinence, pain, uncontrolled body movement, or who get out of bed and walk unsafely without assistance, must be carefully assessed for the best ways to keep them from harm, such as falling.
Assessment by the patient’s health care team will help to determine how best to keep the patient safe. Historically, physical restraints (such as vests, ankle or wrist restraints) were used to try to keep patients safe in health care facilities. In recent years, the health care community has recognized that physically restraining patients can be dangerous. Although not indicated for this use, bed rails are sometimes used as restraints. Regulatory agencies, health care organizations, product manufacturers and advocacy groups encourage hospitals, nursing homes and home care providers to assess patients’ needs and to provide safe care without restraints.The Benefits and Risks of Bed RailsPotential benefits of bed rails include:Aiding in turning and repositioning within the bed.Providing a hand-hold for getting into or out of bed.Providing a feeling of comfort and security.Reducing the risk of patients falling out of bed when being transported.Providing easy access to bed controls and personal care items.
Potential risks of bed rails may include:Strangling, suffocating, bodily injury or death when patients or part of their body are caught between rails or between the bed rails and mattress.More serious injuries from falls when patients climb over rails.Skin bruising, cuts, and scrapes.Inducing agitated behavior when bed rails are used as a restraint.Feeling isolated or unnecessarily restricted.Preventing patients, who are able to get out of bed, from performing routine activities such as going to the bathroom or retrieving something from a closet.Meeting Patients' Needs for SafetyMost patients can be in bed safely without bed rails. Consider the following:Use beds that can be raised and lowered close to the floor to accommodate both patient and health care worker needs.Keep the bed in the lowest position with wheels locked.When the patient is at risk of falling out of bed, place mats next to the bed, as long as this does not create a greater risk of accident.Use transfer or mobility aids.
Anticipate the reasons patients get out of bed such as hunger, thirst, going to the bathroom, restlessness and pain; meet these needs by offering food and fluids, scheduling ample toileting, and providing calming interventions and pain relief.When bed rails are used, perform an on-going assessment of the patient’s physical and mental status; closely monitor high-risk patients. Consider the following:Lower one or more sections of the bed rail, such as the foot rail.Use a proper size mattress or mattress with raised foam edges to prevent patients from being trapped between the mattress and rail.Reduce the gaps between the mattress and side rails.Which Ways of Reducing Risks are Best?A process that requires ongoing patient evaluation and monitoring will result in optimizing bed safety. Many patients go through a period of adjustment to become comfortable with new options. Patients and their families should talk to their health care planning team to find out which options are best for them.
Patient or Family Concerns About Bed Rail UseIf patients or family ask about using bed rails, health care providers should:Encourage patients or family to talk to their health care planning team to determine whether or not bed rails are indicated.Reassure patients and their families that in many cases the patient can sleep safely without bed rails.Reassess the need for using bed rails on a frequent, regular basis.To report an adverse event or medical device problem, please call FDA’s MedWatch Reporting Program at 1-800-FDA-1088.For additional copies of this brochure, see the FDA’s Hospital Bed website.She has volunteered to answer questions.For information regarding a specific hospital bed, contact the bed manufacturer directly.Developed by the Hospital Bed Safety WorkgroupParticipating Organizations:AARPABA Tort and Insurance Practice SectionAmerican Association of Homes and Services for the AgingAmerican Health Care AssociationAmerican Medical Directors AssociationAmerican Nurses AssociationAmerican Society for Healthcare Engineering of the American Hospital AssociationAmerican Society for Healthcare Risk ManagementBasic American Metal ProductsBeverly Enterprises, Inc.Care Providers of MinnesotaCarroll HealthcareDePaul College of LawECRIEvangelical Lutheran Good Samaritan SocietyHill-Rom Co.
, Inc.Joerns Healthcare, Inc.Joint Commission on Accreditation of Healthcare OrganizationsMedical Devices Bureau, Health CanadaNational Association for Home CareNational Citizens’ Coalition for Nursing Home ReformNational Patient Safety FoundationRN+ SystemsStryker MedicalThe Jewish Home and HospitalUntie the Elderly, The Kendal CorporationU.S. Food and Drug AdministrationOctober 2000Revised April 2010 Multiple Sclerosis Centers of Excellence » Veterans » Living with MS Selecting the Appropriate Mattress for People with MS Richard Buhrer, ARNP, MSCN Why do people with MS need special mattresses? What are the various types of mattresses? What are mattress covers? Will the VA cover special mattresses? Why do people with MS need special mattresses? Because of the problems with sensation and movement that are often a component of multiple sclerosis, people with the disease often require special mattresses to keep them safe from developing bed sores and other skin problems.
Another problem that people with MS suffer from is heat intolerance. In the presence of a high ambient temperature (temperature of the inside or outside environment), the nerves damaged by MS cease to function. So that when people with MS become overheated, their ability to move and sense the environment is diminished. Choosing a mattress that will protect the individual from becoming overheated and that will provide skin protection is very important for the health of the person with MS. What are the various types of mattresses? When choosing a mattress, it is important to consider the effects of that mattress on skin protection and heat intolerance. Mattresses may be either static or dynamic. In general, a static mattress refers to a mattress that doesn’t move when a person lies on it. A dynamic mattress is powered by electricity to change the surface under a person to allow for a variety of medical needs. Dynamic mattresses involve at least one of the following technologies: fluidized air, alternating pressure or side-to-side turning.
Fluidized air therapy involves blowing warmed air through a bed of tiny silicone beads creating a surface that is like a “waterbed” but with warm air blowing up through it continuously. This type of surface is used mostly in health care institutions for patients either with very severe pressure ulcers (bedsores) or after surgery to close these wounds. Alternating pressure: Air is pumped into cylinders that are placed parallel to each other inside a mattress. As one set of cylinders inflates, the other set deflates. This way the pressure under any part of the body is relieved on a regular basis. This type of mattress can reduce the number of times a person needs to be turned while in bed. Side-to-side turning: One side of the mattress deflates and the other side inflates, alternating over time, turning the person in the bed gently from side to side. This is normally used for patients with lung problems, but can be used for people with MS as another way to reduce the number of times an attendant must turn a person while in bed.
Of these mattresses, only fluidized air is heated. The heat can be adjusted so that people with MS can use these surfaces, but they carry some risk of overheating. Alternating pressure and side-to-side turning are not heated. Therefore, heat intolerance is not as much of an issue with these mattresses. Viscoelastic or memory foam: One kind of static mattress that gets a lot of attention on TV is made of viscoelastic or memory foam (the Tempur-pedic ™). People with disabilities often find these mattresses difficult to use because they get "stuck" in a hole in the mattress and cannot move themselves out of it. Some medical mattresses are made of this substance but they do not really work out very well for people with MS. Low air loss: This involves an air sack where a small amount of air leaks through the cover on a continuous basis. It helps to control moisture (like sweating). It provides some pressure reduction but the surface doesn't change over time and people need to be turned more frequently on this kind of surface.
The air in a low air loss mattress may be heated and so this could pose problems with heat intolerance for people with MS. Air covered by foam: Another kind of static mattress is filled with air covered by foam. The air is in interwoven but not interconnected air cells that have certain stretchiness (distensibility). That way when a person lies on the bed, the air cells move and adjust to small changes in position. This kind of mattress is a good basic surface for a person who does not have a high-risk of developing bedsores. What are mattress covers? All of these mattresses (except fluidized air) have Gortex ™ covers. This is a slippery fabric that is often used to make rain gear for hiking. It allows moisture to travel in one direction (which is to say, not into the mattress) so that the mattress is protected from moisture, and bowel and bladder accidents. It is customary to cover these mattresses with only one sheet. The goal is to minimize the number of layers between the skin and the surface of the mattress.
Too many layers will increase the risk of bedsores and negate the advantages of the mattress. Gortex™ fabric reduces the friction and shear from the mattress that could also injure the skin when a person is repositioned (especially pulled up in the bed). Lying on these mattresses may feel "sweaty" and warm to the person in the bed and this can be a problem for a person with MS. The only real alternative is to control the temperature in the room where the person is sleeping by using air conditioning or fans. Will the VA cover special mattresses? The VA will only purchase single-bed sized mattresses. Most of them work best on a hospital-type bed frame. If Veterans prefer to sleep with their spouse or partner, then a good quality, soft, commercial mattress is probably the best choice. Air filled adjustable mattresses (for example, the Sleep Number Bed ™) are also available and might be a good choice for people with MS. It is recommended that you review all your mattress choices with your healthcare provider.