Published November 26, 2018

A holistic approach to safety in skilled nursing facilities includes an assessment of resident safety and functioning when in bed.  Residents in long term care are often compromised and frail so to ensure a safe environment, bed safety must be part of an initial and ongoing assessment process.

While many hospitals still include use of bed rails as a standard care item, regulations and best practice in long term encourage a more individualized approach. Guidance can be found in the nursing home regulations, F700 Bed Rails, requiring providers to attempt alternatives prior to installing bed rails.  If bed rails are used, facilities must ensure correct installation, use and maintenance using a systematic approach including:

• Assessing the resident for entrapment prior to the installation of bed rails.
• Reviewing risks and benefits with the resident or their representative and obtaining informed consent prior to installation.
• Ensuring bed size is appropriate for the resident.
• Following manufacturer’s guidelines for installing and maintaining bed rails.

An initial and ongoing individualized resident assessment should be performed including a review of the resident’s behavior, medical condition/diagnosis, medications, presence of delirium, cognitive status, functional mobility status and fall risk. If it is determined that bed rails are needed, documentation must be present to reference the alternatives that were attempted and why they failed to be a viable care plan approach.

The FDA and the US Consumer Product Safety Commission (CPSC) has developed guidelines that should be taken when determining appropriate use and application of bed rails. These guidelines should be evident in facility policies and procedures related to F909 for conducting regular inspection of all bed frames, mattresses, and bed rails as part of a regular maintenance program to identify areas of possible entrapment.

As part of your ongoing review, consider reassessing bed safety when the following occurs:

• Admission or readmission to the facility.
• With a room change.
• With a change in condition.
• With application of an air or concave mattress. Note: An air mattress differs from a regular mattress and can become a safety risk. As a resident rolls and moves in bed, the sides of an air mattress tend to compress increasing the space between the mattress and bed rail and ultimately increasing the risk of entrapment.
• Following a fall.
• With noted behavioral changes.
• With the removal of an air mattress, concave mattress or any other device used in bed (trapeze, wedge pillow, heel flotation device, etc.)

State and Federal guidelines should be reviewed prior to determining which staff members will participate in the assessment process.  Analyzing multidisciplinary assessment findings is preferred when determining the safest and least restrictive environment for residents (i.e., nursing and therapy assessments).

Use of restraints or devices that have the potential to be a restraint should never be implemented for staff convenience.  Providing education to families, residents and staff on the risks associated with use of devices in bed and general bed safety can promote a culture of safety consistent with best practice and Federal and State guidelines.

For assistance with enhancing resident bed safety in your facility, refer to the CMS guidelines or contact Coretactics, Inc. today for a risk analysis and improvement implementation plan.

Sarah Ragone, MSPT, RAC-CT
VP of Reimbursement & Education