Bed Rails in Care Homes (Wales) Policy

Policy Statement

This policy on the safe use of bed rails has been written in line with Health and Safety Executive guidance and the device guidance produced by the Medicines and Healthcare Products Regulatory Agency (MHRA).

It identifies the procedures used by the home to assess the risks that must be managed when it is proposed that a person requires the use of bed rails for safety reasons. The risks are assessed and managed as part of the person’s care plan.

The policy meets the requirements of the Regulated Services (Service Providers and Responsible Individuals) (Wales) Regulations 2017 and accompanying statutory guidance with reference to the regulations on Safeguarding (26 and 27), Regulation 48: Facilities and Equipment, and Regulation 57: Health and Safety.

By implementing this policy, the home aims to make a bed rail accident a “never event”.

Background

Bed rails include bed side-rails, safety sides and bed guards. It is acknowledged that bed rails also act as potential restraints, therefore, the home’s policy is only to use them when absolutely needed to keep a vulnerable person safe in their bed.

Before using bed rails, managers will obtain the written consent of the person or, in the case of someone who has been assessed as without mental capacity to give their consent, their representatives.

{{org_field_name}} recognises that the risks posed by bed rails result from the interaction of the occupant’s behaviour and the suitability of the appliances. It is also aware that injuries, which in a small number of cases have been fatal, are known to be caused by:

poorly fitting or unsuitable bed rails so that parts of the body become trapped, eg between the mattress and the bedrail
poor bed rail design, which leave too large a gap space between the rails
movement of the bed rail away from the side of a divan mattress
thick mattresses or mattress overlays that reduce the effective height of the bed rail so that the person can fall out over the top of the rail
air mattresses that are too light and unbalanced to keep the bed rail assembly in position on a divan bed
bed rails in poor condition due to a lack of maintenance.

In line with MHRA guidance, in carrying out its risk assessments and care plans the home distinguishes between bed rails that are built into the design of the bed (integral type) and those that are added on to an existing bed arrangement (third party type). It is aware that the risks to a person’s safety from, for example, entrapment, are higher for third party types of bed rail and increases its safety measures in proportion to the risks that third party types present.

People who are particularly vulnerable to the risks posed by bed rails include those who have:

communication problems
confusion, agitation or delirium
learning disabilities
dementia
repetitive or involuntary movements
larger or smaller than average body size (which may change entrapment risks)
impaired or restricted mobility
variable levels of consciousness, or those under sedation.

The home understands that the degree of risk is related to the condition of the person in relation to the type of bed rail device used. The home is always prepared to seek advice from other relevant professionals such as occupational therapists and physiotherapists to establish the need for bed rails and the most suitable type of bed rail to be used for any individual.

Grab Handles (Bed Levers)

Grab handles, also known as bed levers or bed sticks, are designed to aid mobility for the person in bed and to help them transfer to and from bed, rather than to prevent falls from bed. Some bed rails can also be used as bed grab handles as they have undergone testing to ensure they can support the additional loads from use in this way. If the bed rail is not appropriate for use as a bed grab handle, this could result in the bed rail breaking.

If the risk assessment demonstrates that the person requires bed rails to prevent falls as well as bed grab handles to aid mobility, then appropriate bed rails which can safely support them when being used to aid mobility should be used.

Grab handles can present the same threats to people’s safety as bed rails, including death, and so should be risk assessed in the same way.

Assessing the Risks Posed by Bed Rails

Managers and the staff involved use bed rails as a clinical decision only after considering other methods that would keep the person safe in bed. However, managers are also aware that under health and safety regulations, once it has been decided that bed rails are necessary, it is essential to provide them; otherwise they could be considered negligent in their duty of care.

The risks of injury increase if the bed rail is unsuitable in relation to the occupant and the type of bed and mattress, therefore, the policy is always to assess using MHRA guidance whether:

the occupant’s head and body is small enough to pass through the bed rail bars
the gap between the bed rail and the side of the mattress will allow the occupant’s body to pass through it, or could trap their head
the bed rail supplier’s or manufacturer’s instructions have been fully followed
the bed rail has been fitted correctly to the bed and is secure — different fittings may be required for different types of bed
there are any gaps present when the bed rail is fitted to the bed that potentially will allow the occupant to become trapped.

The potential risks, as identified by their individual risk assessment should be explained to the person, as appropriate, as well as measures to reduce their risk of falls and entrapment.

The results of the risk assessment with any management plan are always recorded and included in the person’s care plan.

Risk Management of Bed Rails

The home appoints a competent senior staff member to be responsible for making regular checks to ensure that any bed rails fitted remain properly adjusted and continue to be suitable for the occupant.

If there are any changes to the bed, mattress, bed rail, occupant or occupant’s condition, the risks will be reassessed, and routine reviews will be scheduled and completed regularly at an interval appropriate for the person’s needs.

All bed rails and fittings are inspected and maintained on a planned schedule. The home keeps full records of inspections and maintenance, which it can make available to external inspectors.

Accident Reporting

Although the home aims to make bed rail accidents “never events”, it recognises that there could be occasions when a person is or might be injured by the faulty use of any bed rails applied or through defects that have arisen.

In the event of a person being noticeably harmed (as a result of a bed rail injury) the home will report the matter to the local Safeguarding Adults Authority so that it can take appropriate action.

It will also exercise its Duty of Candour by informing and discussing any adverse event arising from bed rail use with the person and their representatives as part of its own investigations.

{{org_field_name}} recognises its responsibility under the Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 2013 to report any accidents resulting in injuries to the bed occupant that might result from the misuse of bed rails to:

the Care and Social Services Standards Inspectorate for Wales (CSSIW) under its notifications requirements
the MHRA under its reporting of adverse incidents procedure.

Training

The home ensures that all staff responsible for selecting, fitting and checking bed rails are trained and competent to do so.

New staff learn about and how to implement the policy in line with the Social Care Wales: All Wales Induction Framework for Health and Social Care.

The home also ensures that staff involved in making beds and helping occupants in and out of bed, who may also have to remove and replace bed rails, receive instruction and training in the correct fitting and adjustment of the bed rails. The training is always in line with the supplier’s or manufacturer’s instructions.

References

Safe Use of Bed Rails (December 2013), available at www.mhra.gov.uk (website to be www.gov.uk in 2014)
Health and Safety at Work, etc Act 1974
Management of Health and Safety at Work Regulations 1999.

Latest Amendments

This policy has been amended to include guidance issued by MHRA in December 2013. Changes have been made to the policy statement and the accident reporting section.

Responsible Person: {{org_field_registered_manager_first_name}} {{org_field_registered_manager_last_name}}

Reviewed on: {{last_update_date}}

Next Review Date: {{next_review_date}}

WCH28. Bed Rails in Care Homes