, therefore emphasises the need for careful selection of patients for whom bedrails are to be used, as well as the need for monitoring and maintenance of hospital bed systems.
Bedrails are commonly used as safety devices to prevent people falling from bed. However, although the risk for any individual is extremely low, people can and have become trapped or even strangled in almost all of the spaces that can exist between bedrails or between mattresses, rails, and head- or foot-boards.
The four zones within the bed system which account for 80% of reported entrapment incidents and for which the FDA provide dimensional guidance were assessed. Zone 1 is any open space between the perimeters of the rail; zone 2 is the space under the rail or between the rail supports; zone 3 is the space between the inside surface of the bedrail and the mattress and zone 4 is a gap between the mattress and rail at the end of the rail. Zones 1 pose a risk of head entrapment, and gaps should be <120 mm and zone 4 a risk of neck entrapment and gaps should be <60mm. Zone 5, the gap between the head board and end of side rail, should be <60 mm, while zone 6, the gap between the foot board and end of side rail, should be <60 mm or >318 mm; zone 7, the gap between split side rails should also be <60 mm or >318 mm. A specialised cone and cylinder tool was used in accordance with the recommendations of the FDA and the British Health and Safety Executive.
Assessors examined bed systems in a large Irish teaching hospital to determine the potential for patient entrapment. The study was carried out in six wards taking acute admissions. Bed type [hydraulic adjustable (HA) or electric profiling (EP)] and manufacturer and mattress type and manufacturer were noted. Only beds where all test zones on all accessible sides passed received an overall pass.
Sixty of 145 beds on the selected wards were examined. In some cases, it was only possible to assess one side of the bed to avoid interfering with a patient sitting in a chair beside the bed; thus, 91 of 290 sides were examined. Of the 60 beds, 22 were EP and 38 were HA beds. Only 5 (8.3%) beds, all EP beds, received an overall pass; 10 (16.6%) beds, all HA beds with non-original rails, failed all zones. Two recurring issues accounted for many of the failures, especially in zones 2 and 3: mattresses were the wrong size (usually too narrow) or their perimeters were too compressible; and bedrails were loose or were poorly maintained with bent or worn components which allowed significant lateral movement.
Shaun T. O'Keeffe, one of the report's authors, said: "On-going monitoring and maintenance of bedrails would avoid some of the problems identified in this study and should occur in all heath care institutions. Other problems are less easily solved. It seems inevitable that there will be a multitude of bed types and of bed-mattress combinations in large acute hospitals. Replacing older bed stock is desirable but costly and is inevitably a long-term process although it is essential that compliance with dimensional guidelines is an important factor in bed procurement decision-making.
"It is important that staff should be aware of the potential for entrapment, and ensuring that bedrails are only used when appropriate will at least limit the number of patients for whom one need have particular concern regarding entrapment. If bedrails are to be used, the appropriateness of the bed, rail and mattress combination for that particular patient should be considered."