The use of side rails in the nursing home setting has been met with scrutiny over the past several years. Many serious injuries and death have occurred from the use of side rails.
The following are potential risks of side rails:
- Strangling, suffocating, bodily injury, or death when residents or part of their bodies are caught between rails or between bed rails and mattresses
- Falls with serious injuries when residents climb over side rails
- Skin bruising, cuts and scrapes
- Agitated behavior when used as a restraint
- Feelings of isolation or restriction
- Decline in mobility and ability to perform self-care activities
- Increased risk of dehydration – unable to reach bedside fluids
Those who have problems with memory, sleeping, incontinence, pain, uncontrolled body movements, or who get out of bed and walk unsafely without assistance are at high risk for injury due to side rails.
For some nursing home residents, the use of short (top) side rails may be beneficial to assist with turning and positioning, but again they do pose a risk. Full side rails as restraints are prohibited under federal and state guidelines unless they are necessary to treat a resident’s medical symptoms. Some facilities are opting not to use side rails for any reason and opt for low beds, grab bars on the wall, over-bed trapezes, concave mattresses, and body pillows to protect residents from rolling out of bed and aid in positioning.
When side rails are used they must be secured appropriately and have functioning latches. Spaces within side rails, between upper and lower rails, between rails and the mattresses, between side rails and the bed frame, or spaces between side rails and the head/footboard of the bed must be small enough that they cannot entrap limbs, neck or upper body and cause injury or death.