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Preventing Bed Rail Entrapment Cheat Sheet (DRAFT) by [deleted]

Avoiding use of Bed Rails

This is a draft cheat sheet. It is a work in progress and is not finished yet.


Patients who have problems with memory, sleeping, incont­inence, pain, uncont­rolled body movement, or who get out of bed and walk unsafely without assist­ance, must be carefully assessed for the best ways to keep them from harm, such as falling. Assessment by the patient’s health care team will help to determine how best to keep the patient safe. Histor­ically, physical restraints (such as vests, ankle or wrist restra­ints) were used to try to keep patients safe in health care facili­ties. In recent years, the health care community has recognized that physically restra­ining patients can be dangerous. Although not indicated for this use, bed rails are sometimes used as restraints


Aiding in turning and reposi­tioning within the bed.
Providing a hand-hold for getting into or out of bed.
Providing a feeling of comfort and security.
Reducing the risk of patients falling out of bed when being transp­orted.
Providing easy access to bed controls and personal care items.


Strang­ling, suffoc­ating, bodily injury or death when patients or part of their body are caught between rails or between the bed rails and mattress.
More serious injuries from falls when patients climb over rails.
Skin bruising, cuts, and scrapes.
Inducing agitated behavior when bed rails are used as a restraint.
Feeling isolated or unnece­ssarily restri­cted.
Preventing patients, who are able to get out of bed, from performing routine activities such as going to the bathroom or retrieving something from a closet.

Avoiding Bed Rail Use

The FDA says that most patients can be kept in bed without bed rails and asks healthcare workers to consider the following:
● Use beds that can be raised and lowered close to the floor to accomm­odate both patient and healthcare worker needs
● Keep the bed in the lowest position with wheels locked
● When the patient is at risk of falling out of bed, place mats next to the bed, as long as this does not create a greater risk of accident
● Use transfer or mobility aids
● Monitor patients frequently
● Anticipate the reasons patients get out of bed such as hunger, thirst, going to the bathroom, restle­ssness and pain; meet these needs by offering food and fluids, scheduling ample toileting, and providing calming interv­entions and pain relief.

Bed Rail Entrapment Zones

FDA Potential Zones of Entrapment

Three key body parts at risk for life-t­hre­atening entrapment in the seven zones of a hospital bed system.


Zone 1 - Within the Rail
Zone 2 - Under the Rail, Between the Rail Supports or Next to a Single Rail Support
Zone 3 - Between the Rail & 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 & the Side Edge of the Head or Foot Board
Zone 7 - Between the Head or Foot Board & the End of the Mattress
Source: Hospital Bed System Dimens­ional and Assessment Guidance to Reduce Entrapment - Guidance for Industry and FDA Staff