Safety First Bed Rail

As lawyers, we are likely to have consulted the clients and their families following a fall from a hospital or nursing home bed. These falls result in broken arms, legs and hips, and often even more serious injuries such as fractures of the skull. (Or the patient's family) immediate response to such injury is unfortunate, it is the fault of the hospital, nursing home, nurse or physician's failure to have raised bedside rails and put in place to prevent such falls. The typical reaction is based on the assumption that the bed rails, when properly used, prevents the patient / resident from falling out of bed and suffering injuries. However, bed rails are not safety devices benign and this article will address the dangers created by their use.

bed rails have been in existence for years and are manufactured by several different companies with many configurations and models. A quick search of the internet reveals a number of medical supply companies that manufacture and sell these products. The most common models are the bars full length bed rail, the rail three-quarter length, half length rails, quarter-length and split-rail configuration (often the most dangerous).

bed rails are used extensively in hospitals and nursing homes. In hospitals, their use is generally a decision to care rather than based on the order of a physician. However, in nursing homes, federal regulations require an order from a doctor if the side rails must be used, such as regulations recognize side rails as a form of coercion. Despite the requirement for nursing homes, doctor's orders are often not obtained because of the belief that bedrails are simply a safety device. It is a misconception bed rails often cause injury or death.

There has been little studied or published on the risks and benefits of bed rails. However, reports of adult deaths and injuries of bed rails on file with the U.S. Consumer Products Safety Commission (CPSC) (incidents from 1993 to 1996) provide important information for lawyers investigating an allegation of negligence potential. The CPSC information reflects only sixty-four patients died as a result of the use of bed rails. In addition, it is not unrealistic to conclude that the actual number of deaths in patients far exceeded the reported deaths. Whatever the actual frequency of deaths, 70% of deaths of patients reported the result of entrapment between the mattress and the bed rail so that the patient's face was pressed against the mattress. 18% percent of the deaths reported were the result of entrapment and compression of the neck in the bed rails. Finally, 12% two percent of reported deaths were caused by being trapped by the rails after sliding partially off the bed, causing a flexion of the neck and chest compression.

The second important source of information comes from the U.S. Food and Drug Administration. The FDA has issued a security alert in August 1995 on the risk of jamming and security that accompany the use of bedside rails. The security alert was sent to hospital administrators, hospital associations, nursing homes, risk managers, engineers bio-medical/clinical, and directors of nursing. The alert is not specific to a manufacturer or particular design of the side rail, but has warned healthcare providers that the FDA had received 102 reports of incidents involving the head and body entrapment side rails between 1990 and 1995 . The 102 reports of entrapment has caused 68 deaths, 22 wounded and 12 trapping injury. These unfortunate events occurred in hospitals, nursing homes and private homes. The majority of jamming involved elderly patients.

In part, the FDA safety alert has recommended the following actions to prevent deaths and injuries from entrapment at the hospital B.