This SIM provides advice to Inspectors who regulate health and social care services. It deals with the management of the risks to people who use bed rails.
Analysis of accident data continues to highlight the serious issue of injuries involving bed rails. The term ‘people who use care services’ is used to describe patients, residents and others who use care services.
Bed rails (also known as bed side-rails, cot-sides, safety sides and bed guards) are used extensively to protect vulnerable people from falling out of bed. There are several causes of injury, the most serious being entrapment by the head, neck or chest. This may lead to death from asphyxiation. Injuries also arise from a person attempting to climb over the rails, and falling, or striking their head against the rails.
Between 2001 and 2009 there were 21 RIDDOR reported bed rail related deaths in the UK, as well as numerous injuries.
Inspectors should use this SIM as a guide in assessing whether the care provider is adequately managing the risks from using bed rails.
Failings associated with bed rail use include:
The risks are well known and publicised. Enforcement action should be considered where there are failings to assess or control the risks. Enforcement action should have a positive impact on dutyholders in these sectors.
There are numerous examples of successful enforcement action. In May and June 2011 the owners of separate care homes were fined £70,000 and £65,000 respectively following fatalities involving bed rails.
Inspectors should look at the following elements of the risk management system:
Risk assessment should consider:
HSL have produced a simplified risk assessment procedure that can be used by care providers. The risk assessment procedure is included in Appendix 1.
Measures identified by the risk assessment must be implemented. Checks should also be made by a responsible person whenever bed rails are used to ensure that they remain properly adjusted and suitable for the patient. The risk assessment should be reviewed if the bed, mattress, occupant or bed rail changes. Employers and employees need to know what bed rails, beds and mattress combinations are suitable for those they care for.
Significant numbers of incidents are caused by a lack of maintenance. Problems include loose fixings, missing clamps and worn or bent components; these can lead to bed rails moving out of position and becoming unsafe. These must be identified and remedial action taken to prevent injury.
Employers should ensure that all employees who are responsible for selecting, fitting and checking bed rails have received adequate training. Other staff, such as care assistants and domestics who make beds and help clients in and out of bed may also remove and replace bed rails and, if so, will need appropriate information and instruction. All employees who might change mattresses, beds or bed rails should be aware of the correct combinations and the safety implications. Equipment suppliers may be able to provide training on use of their equipment.
Inspectors should be familiar with both MHRA and HSE guidance on safe use of bed rails and should have access to measuring equipment to help assess compliance. In addition, HSL has testing ‘cones’ to replicate adult head and neck dimensions.
The Health and Social Care Services Unit would welcome information about any incidents, enforcement action, campaigns or initiatives on this issue. Contact via: firstname.lastname@example.org
Liaison with other regulators
Guidance on the roles of other regulators is available on HSE’s website.
Bed rails are medical devices / equipment as defined in the Medical Devices Regulations 2002, where their intended purpose is to prevent falls in health and social care. The regulations are enforced by the Medicines and Healthcare products Regulatory Agency (MHRA) and Inspectors should contact them in line with our liaison agreement when investigating bed rail incidents.
MHRA has produced a Device Bulletin DB2006 (06) ‘Safe use of bed rails’ (under revision). This is issued within Scotland by Scottish Healthcare Supplies (SHS) under SAN(SC) 07/08.
MHRA has issued other information on bed rails:
Health and Safety at Work Etc Act 1974, Management of Health and Safety at Work Regulations 1999 and Provision and Use of Work Equipment Regulations 1998 all apply. Inspectors should be aware of the guidance on RIDDOR reporting in health and social care.
BS EN 60601-2-52:2010: Medical electrical equipment – particular requirements for basic safety and essential performance of medical beds (Appendix 3). This standard replaces BS EN 1970:2000 (Appendix 2) and BS EN 60601-2-38 on 1st April 2013. The standard details dimensional requirements for bed rail design and supply. The main changes are:
|Description||Old BS EN 1970:2000||New BS EN 60601-2-52:2010||Notes|
|Height of the top edge of the side rail above the mattress without compression||≥ 220mm||≥ 220mm*||*Where a speciality mattress or mattress overlay is used and the side rail does not meet ≥ 220mm a risk assessment shall be performed to assure equivalent safety|
|Gap between head board and end of side rail||≤ 60 or ≥ 250mm||≤ 60||Most disadvantageous angle between head board and side rail|
|Gap between footboard and end of side rail||≤ 60 or ≥ 250mm||≤ 60 or ≥ 318mm|
|Smallest gap from any accessible opening between side rail and mattress platform||
If gap between footboard / headboard is ≥ 250mm then gap is ≤ 60mmIf gap between footboard / headboard is ≤ 60mm then gap is ≤ 120mm
|Gap between split side rails||≤ 60 or ≥ 250 to ≤ 400mm*||≤ 60 or ≥ 318mm||* when in horizontal position|
|Gap between side rail and mattress in ‘plan’ elevation||Not specified||Perform test*||* 120mm aluminium cone is positioned between mattress and side rail to determine if gap is acceptable or not|
HSL literature review - ‘Entrapment and falls from the use of bed rails’ (ERG/08/39).