Recommendations for Health Care Providers Using Adult Portable Bed Rails

Any decision regarding adult portable bed rail use or removal should be made based on the individual patient or resident assessments. If a bed rail has been determined to be necessary, steps should be taken to reduce the known risks associated with its use. To learn more about the patient or resident assessment, see the Clinical Guidance for the Assessment and Implementation of Bed Rails in Hospitals, Long Term Care Facilities and Home Care Settings.

Before you install bed rails:

• Make sure the individual is an appropriate candidate for bed rails. Bed rails should not be used as a substitute for proper monitoring, especially for people at high risk for entrapment such as those with cognitive impairment.
• Follow the recommendations in the ASTM F3186-17: Standard Specification for Adult Portable Bed Rails and Related Products for home care facilities and long term care facilities.
• Only use bed rails that conform with ASTM F3186-17.
• Follow the recommendations in the FDA guidance "Hospital Bed System Dimensional and Assessment Guidance to Reduce Entrapment" for health care facilities and the Clinical Guidance for the Assessment and Implementation of Bed Rails in Hospitals, Long Term Care Facilities and Home Care Settings.
• Review warning labels and instructions for use provided with the bed rails. See the example of a warning label recommended by ASTM F3186-17 for adult portable bed rails below.

Reprinted, with permission, from F3186-17 Standard Specification for Adult Portable Bed Rails and Related Products, copyright ASTM International. A copy of the complete standard may be obtained from ASTM International, www.astm.org.

• Be aware that not all bed rails, mattresses, and bed frames are interchangeable and not all bed rails fit all beds. Check with each manufacturer to make sure the bed rails, mattress, and bed frame are compatible, because most bed rails and mattresses are purchased separately from the bed frame.
• Bed rails should be selected and placed to discourage climbing over rails to get in and out of bed, which could lead to injury or death from falls.
• Avoid the routine use of adult bed rails without first conducting an individual patient or resident assessment.
• Restrict the use of physical restraints, including restrictive use of bed rails, or chest, abdominal, wrist, or ankle restraints of any kind on individuals in bed.

When installing and using bed rails:

• Select an appropriate bed rail for age, size and weight of the person using the bed rail.
• Be aware that not all bed rails, mattresses, and bed frames are interchangeable and not all bed rails fit all beds. Check with the manufacturers to make sure the bed rails, mattress, and bed frame are compatible.
• Follow the health care facility's procedures and manufacturer's recommendations and specifications for installing and maintaining bed rails for the particular bed frame and bed rails used.
• If the bed rail includes a safety strap or bed rail retention system, ensure these are attached to the rail and secured to the bed frame according to the manufacturer's instructions.
• Use caution when using bed rails with a soft mattress as this may increase risk of entrapment between the mattress and bed rail.
• Inspect and regularly check the mattress and bed rails to make sure they are still installed correctly and for areas of possible entrapment and falls. Regardless of mattress width, length, and depth, the bed frame, bed rail, and mattress should leave no gap wide enough to entrap a patient's head or body.
• Regularly assess that bed rails remain appropriately matched to the equipment and to the patient's needs, considering all relevant risk factors.
• Inspect, evaluate, maintain, and upgrade equipment (beds, mattresses, and bed rails) to identify and remove potential fall and entrapment hazards.
• Re-assess the person's needs and re-evaluate the equipment if an episode of entrapment or near-entrapment occurs, with or without serious injury. This should be done immediately because fatal "repeat" events can occur within minutes of the first episode.
• Be aware that gaps can be created by movement or compression of the mattress which may be caused by patient weight, patient movement or bed position, or by using a specialty mattress, such as an air mattress, mattress pad or waterbed.
• When in doubt, call the manufacturer of the bed rails for assistance.