Bed rail entrapment, injury and deaths in nursing homes

While bed rails can protect nursing home residents from falling out of bed, entrapment injuries are unfortunately far too common.

Nursing homes and long term care facilities must use bed rails with extreme caution and follow set procedures to ensure residents safety.

This article examines how Arizona nursing homes should be using bed rails, the types of injuries that can happen if they’re mis-used and what legal recourse you have if something goes wrong.

What is a bed rail?

A bed rail is a device that is used on the sides of beds, often in nursing home or long term care facility settings.

Bed rails are made out of either plastic or metal and typically run half or the entire length of the bed.

Why are bed rails used by nursing homes?

Bed rails are used for nursing home residents that have trouble moving independently.

Bed rails are typically used in nursing home and long term care facility settings to They can assist residents with repositioning in bed, help with transferring out of the bed, or prevent the resident from falling out of bed.

However, careful consideration should be given by the nursing home before adding a bed rail to a nursing home resident’s care plan.

At no point should they be used by staff as a substitute for personal monitoring of residents. This is especially true for residents at a high risk of bed rail entrapment.

Bed rails may only be used by nursing home or long term care facilities if a resident’s symptoms warrant use of the bed rails. Those symptoms must be documented properly in the resident’s file, and the symptoms must be reassessed by the staff members on a regular basis.

A physician’s order is required for use of a bed rail. The nursing staff may not independently decide a resident is in need of a bed rail.

What is bed rail entrapment?

The most common injury that occurs from a resident using a bed rail is bed rail entrapment.

This happens when a resident’s head, chest or neck becomes lodged in the tight space around the bed and the bed rail.

The problem with bed rails is that there are gaps between the rails, which can cause a resident’s head, chest or neck to become lodged in the bed rail.

Bed rail entrapment occurs when a nursing home resident becomes caught, stuck, wedged or trapped between one of seven “zones” of a bed rail:

• Zone 1: Within the bed rail
• Zone 2: Under the bed rail, between the bed rail supports or next to a single rail support
• Zone 3: Between the bed rail and the mattress
• Zone 4: Under the rail at the ends of the rail
• Zone 5: Between split bed rails
• Zone 6: Between the end of the rail and the head or foot board of the bed
• Zone 7: Between the end of the mattress and the head or foot board

These injuries are more likely to happen when the bedrail isn’t being used properly, typically:

• If the bed rail is too loose
• If the bed rail doesn’t fit the resident’s bed correctly
• If the mattress is not a size recommended for use with bed rails

Which residents are at greatest risk?

Nursing home or long term care residents that suffer from the following conditions are at more risk of bedrail entrapment:

• Delirium
• Agitation
• Pain
• Uncontrolled body movement
• Hypoxia
• Urinary tract infections
• Fecal impactions

This is in part because residents with these conditions are typically frail and cannot properly control their bodily movements while in bed.

What kind of injuries may occur with bed rail entrapment?

The most common injuries associated with bed rail entrapment are:

• Suffocation
• Strangling
• Skin injuries

In severe cases when a resident is trapped for a sustained period of time residents have died following bed rail entrapment.

Are nursing homes liable for bed rail entrapment accidents?

In the context of personal injury, a nursing home facility may be liable for a resident’s death as a result of bed rail entrapment.

Risk of using a bed rail

By admitting a resident to its facility, the nursing home is required to adhere to a standard of reasonable care while performing any acts that could foreseeably harm others.

This factor is key in bed rail entrapment cases. A nursing home may defend itself in a bed rail entrapment injury or death by arguing that the injury or death was not foreseeable due to the bed rail. This is false.

The Federal Drug Administration (FDA) has recognized that bed rail entrapment in nursing home settings has been and continues to be a serious issue for over twenty years.

The FDA has issued numerous bulletins on the use of bed rails and detailing the risks associated with using bed rails in a nursing home setting. A nursing home or long term care facility should not, and cannot, use the defense that it did not know of the risks of bed rails with eldery residents.

Restraint or assistive device

Another legal issue that may arise in a bed rail entrapment case is whether or not the bed rail was used as a restraint or assistive device.

A bed rail is not considered a restraint if it:

1. Is a partial bed rail and
2. Allows a resident to enter and exit the bed independently.

If a bed rail does not meet both of these criteria, then it is being utilized by the nursing home or long term care facility as a restraint.

If the nursing home determines that a bed rail must be used as a restraint, then informed consent must be obtained by the proper representative of the resident.

A consent form must be obtained from the nursing home or long term care facility from the representative of the resident who is in charge of making legal decisions for the resident. The consent form must include the following:

• The medical needs to the resident that require use of the bed rails
• Why the resident would benefit from use of bed rails and the likelihood of success
• The resident’s risk from use of the bed rails and how those risks will be handled by the nursing home or long term care facility’s staff
• What alternatives were provided to resident that failed to meet the resident’s needs, and alternatives considered, but not attempted, because they would be inappropriate for the resident

If a consent form is obtained and bed rails are used for a resident, then ongoing assessment of the resident must be completed by the staff to determine if the resident continually requires the use of bed rails.

The use of bed rails does not have to be permanent and reassessment by staff and doctors must be done on a continuous basis.

Staff training using bedrails

If it’s determined that a resident is a candidate for a bed rail, the staff must be trained on how to:

1. Install the bed rails properly to prevent bed rail entrapment
2. Know how to identify issues if they arise with bed rails once they are installed

Proper installation of the bed rails includes the following:

• Selecting the appropriate bed rail for the size, age and weight of resident using the bed rails
• If a bed rail does not properly fit a bed and/or mattress, contacting the manufacturer of the bed rail so that the installation is proper
• Training in proper maintenance of the bed rail
• Training in proper maintenance of the bed and mattress

If you suspect that your loved one was injured as a result of bed rail entrapment, it is important to contact a nursing home abuse attorney immediately.

Legal help with bed rail cases

If your loved one has suffered a nasty injury or died using a bed rail then it’s likely you’ll want the incident to be properly investigated.

Speaking to an experienced nursing home abuse lawyer can help ensure this happens. If the nursing home has been negligent or not followed the right procedures to protect your loved one then you could also have the option to take further legal action.

Speak to the team at Thompson Law for a free, no obligation review of your case today.