Am Fam Physician. 1998;57(2):348-350
Bedrails are used extensively in hospitals and nursing homes for restraint or safety. In hospitals, the use of bedrails is typically a nursing decision. In nursing homes, federal guidelines mandate a physician's order when bedrails are used as restraints. Bedrails have been associated with a number of deaths despite the fact that they are often thought to be an innocuous safety feature. Parker and Miles reviewed the ways that bedrails may cause death and offered suggestions for preventing these types of deaths.
United States Product Safety Commission files were reviewed for deaths occurring in adults who were in bed and whose death was related to the use of bedrails. Patients were excluded if other restrictive devices, such as chest or pelvic restraints, were used. Demographic data and descriptive information were collected for cases occurring from 1966 through 1996, and illustrations were made to recreate the mechanism of injury in order to categorize the types of death.
Fifty-one of the 74 deaths recorded occurred in patients older than 70 years of age, with 26 deaths occurring in patients between 81 and 90 years of age. Women were involved more than twice as often as men, with 69 percent of the deaths occurring in women and 28 percent occurring in men. Deaths were categorized into three groups. Most deaths (70 percent) were caused by suffocation resulting from entrapment between the rail and the mattress and/or the bed itself. Latch failure that resulted in the bedrail falling on the patient's head occurred in 18 percent of deaths. In these cases, the patient's head was caught between the vertical rails. The third group of patients (12 percent) died after sliding on either the abdomen or the back through the space between the head and foot rails and becoming lodged with the neck either hypo-extended or hyperextended by the floor. In four patients, the exact mechanism of injury could not be determined.
The authors conclude that bedrails should not be used in ambulatory patients. Use of bedrails may be appropriate in patients who are sedated and on life-sustaining systems. Design recommendations include limiting the space between the head and the foot rails to no more than 6 cm to prevent entrapment injuries. Other design recommendations are listed in the accompanying table.