Bed Rails

Injuries to confused or elderly patients arising from the nonuse of bed rails are a continuing source of negligence litigation.

Individual hospital policy usually directs discretionary or mandatory application of this form of restraint for patients unable to foresee or prevent accidental self-injury because of their medical conditions or treatments. Individual nurses responsible for care of the patient at the time of injury are generally those sued for substandard interpretation or implementation of such policy.

Historically, cases have proved indefensible[1],[2],[3] if the indications for their use were clearly present, or there were explicit medical orders, and if the nurse or other care-giver failed to place or replace rails.

PRACTICE POINT

The benefits of bed rails have not been researched

9 years ago, in the State of Georgia, a plaintiff's personal physician argued successfully in defence of hospital policy that raised bed rails were liable to lead to more severe injury if a confused patient succeeded in scaling them before falling to the floor[4]. His contention was that if such patients' conditions warranted self-protection, they should receive the benefits of safer forms of restraint.

PRACTICE POINT

The USE of bed rails rather than other restraints may be found negligent if they cause or aggravate injury

A recent Minnesota study[5] reviewed the 74 US deaths registered between 1993 and 1996 as resulting from entrapment between mattress and bed rails. The authors commented that their usefulness had not been validated by empirical research and called for radical curtailment of this form of restraint.

Their studies led them to believe that the reported deaths were the "visible tip of a much larger problem", pointing out that there were medicolegal disincentives to accurate reporting.

PRACTICE POINT

Unrecorded entrapment between mattress and bed rails should be considered when confused or elderly patients die unexpectedly in hospital