Bedrails Policy

Policy Statement

This policy on the safe use of bed rails has been written in line with Health and Safety Executive (HSE) guidance and the device guidance produced by the Medical and Health Care Product Regulatory Agency (MHRA) and Regulation 12: Safe Care and Treatment of the Health and Social Care Act 2008 (Regulated Activities) 2014.

It identifies the procedures used at 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.

Bed rails include bed side-rails, safety sides, and bed guards. It is acknowledged that bed rails also act as potential restraints, therefore Cavendish Homecare’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.

Background

Cavendish Homecare 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 Cavendish Homecare 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). We are aware that the risks to a person’s safety from, for example, entrapment, are higher for third party types of bed rail and we increase our safety measures in proportion to the risks that third party types present.

Wherever possible Cavendish Homecare will recommend a bed that enables the integral type of bed rails to be applied for anyone whose bed safety requires such an appliance; particularly vulnerable people including 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.

Cavendish Homecare understands that the degree of risk is related to the condition of the person in relation to the type of bed rail device used. We are always prepared to seek advice from other relevant professionals such as Occupational Therapists and Physio Therapists 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 should 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 MRHA 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

Cavendish Homecare is 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. Cavendish Homecare keeps full records of inspections and maintenance, which it can make available to external inspectors.

Accident Reporting

In the event of a person being harmed as a result of a bed rail injury Cavendish Homecare will adhere to the Accident & Incident Policy and Procedure.

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

Cavendish Homecare 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 Quality Commission under its Notifications requirements
  • the MHRA under its reporting of adverse incidents procedure.

Training

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

Cavendish Homecare 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.

 

Date:  July 2024

Version: Implementation

Source     Croner