In 2006, the FDA issued guidance for hospitals and nursing homes about how to make corrections to existing beds that might be in use at their facilities and that might not conform to the safety standards recommended for beds with side rails. These local corrections are relatively easy and inexpensive. However, they are not routinely implemented and when they are implemented they are not always implemented in a reliably safe way.
The FDA recommends that each facility begin by identifying employees who will be responsible for measuring beds in the facility and overseeing any necessary corrective action. It is important that this be an ongoing activity because as mattresses are worn down and pieces of each bed system are replaced, dangerous gaps can be created. It is suggested that the employees who are charged with this task begin with the divisions of the facility that might have patients who are at high risk for entrapment. They should then inventory all of the beds in the facility, beginning with the high risk divisions, for conformance to the FDA's bed system entrapment dimensional guidance.
After the facility has been evaluated, all necessary corrective actions should be implemented. The exact corrective action depends on where on the bed system the problem is located. The FDA has identified 7 zones were entanglement is most likely to occur. If there is a problem with a large opening in the bed rail (zone 1) then the facility should contact the manufacturer and inquire about retrofits to correct the entrapment risk. If there is a problem with a gap between the mattress and the side rail (zones 2, 3, 4 and 7) then the facility should try and locate mattresses of appropriate size to close the gap and make the bed safe. Other fixes including mattress overlays or positioning poles should also be considered. Finally, removing the bed rails should be considered and carefully evaluated by the medical team. They may be able to think of alternatives to bed rails that will keep patients safe without the entrapment risk.
The majority of the time the corrections are add on or accessory pieces that can narrow the gaps created by the bed rails and thereby lower the risk of a person's head, neck, chest or other body part becoming stuck. It is important that these add on pieces be carefully, thoroughly and routinely evaluated to make sure that they do not move or fall out. It is not enough that the corrective actions be taken. The corrections also need to be carefully monitored so that patients are safe from entrapment as well as other dangers.
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