Bed Rails: What Every Care Provider Should Know

A common safety tool used in healthcare settings—bed rails—has been linked to preventable injuries and deaths. 

Whether you work in hospice, home health, senior living, or another care environment, you’ve likely used bed rails as part of a patient or resident’s care. They can offer support with repositioning, assist with safer transfers, promote independence, and provide a sense of comfort and security.

The U.S. Food and Drug Administration (FDA) recognizes that bed rails may be appropriate for some individuals—but they can also pose serious risks by acting as a restraint. Understanding these dangers can help you make informed decisions for those in your care.

Potential Risks of Bed Rails: 

• Strangling, suffocating, bodily injury, or death
• Serious injuries from falls
• Skin bruising, cuts, and scrapes
• Limb entrapment
• Broken bones and fractures
• Agitation when bed rails are left up prohibiting movement
• Feeling isolated or unnecessarily restricted
• Preventing individuals who can get out of bed from performing routine activities

Entrapment: A Major Bed Rail Hazard

Among the risks associated with bed rails, entrapment is one of the most serious and widely recognized safety concerns. In fact, the United States Consumer Product Safety Commission (CSPC) notes that 92% of fatalities associated with portable bed rails are from entrapment.

The FDA's Zones of Entrapment

There are specific zones in hospital beds where entrapment can occur, and understanding these areas can help reduce the risk of injury and improve patient and resident safety.

7 Zones to watch for:

To help assess entrapment risks, consider using the Bed Safety Entrapment Kit developed by the Hospital Bed Safety Workgroup (HBSW). The kit can help you evaluate hospital beds with bed rails, and identify potential hazards before they lead to injury.

Bed rails are not always necessary. 

Before using a bed rail, assess each individual to determine whether it is appropriate for their specific care needs and aligns with agency and state regulations. In many cases, other safety measures may provide enough protection without introducing the risks associated with bed rails. Decisions about use consider the patient or resident’s level of mobility, fall risk, and overall health status.

The FDA recommends considering the alternatives of bed rail use:

• Use beds that can be lowered close to the floor such as high/low beds.
• Use roll guards and/or foam bumpers and wedges.
• Keep beds in the lowest position with wheels locked.
• Place fall mats next to the bed for patients at risk of falling, as long as this does not create an additional hazard.
• Use transfer or mobility aids.
• Monitor patients frequently, especially those at higher risk for falls.
• Anticipate the reasons individuals get out of bed:
  • Hunger
  • Thirst
  • Going to the bathroom
  • Restlessness and pain
  • Confusion 

You play a critical role in reducing preventable harm related to issues caused by bed rail use. By carefully assessing needs, understanding the risks, and using appropriate precautions, you support safer care. Consider reviewing state and federal regulations in your area of operation, prior to implementing side rail utilization.

"Regardless of the healthcare setting you work in, we recognize how much you do behind the scenes to keep patients and residents safe," says Christina Boyle, Glatfelter Healthcare’s Director of Client Risk Solutions. “Please continue to 'pause for the cause' and prioritize risk mitigation and safety.”