Before we can determine the best way to keep elderly patients safe in their nursing home beds, it is important that we understand what is putting them at risk of harm. Often, bed rails are used in nursing homes to keep patients safe. However, sometimes bed rails can have just the opposite effect. The FDA has reported that people can be suffocated or strangulated as a direct result of using bed rails. Bed rail accidents can cause serious injury or even death.

In order to prevent bed rail accidents, it is important to understand what these injuries are and how they occur. Typically, patient injuries occur when the patient falls into a gap created by the bed rails or has a body part that becomes trapped in a gap. The four most common types of entrapment occur when a person falls:

1. Through the bars of an individual side rail;
2. Through the space between two split side rails;
3. Between the side rail and the mattress; or
4. Between the headboard or footboard, side rail and the mattress.

Death may occur if the patient's head or neck gets trapped in one of the ways described above. Fractures, cuts and other injuries can occur if a patient's arm, hand, leg, foot or other body part gets caught in one of these ways.

Injuries can also occur if a patient attempts to climb over the bed rails to get out of bed. A patient who is confused, disoriented, or who is not receiving adequate attention from the nursing home staff might not be able to figure out how to lower the bed rails and may attempt to climb over the rails which can result in a fall. The injuries from these falls can be serious especially in an elderly patient who might break a hip or suffer from another serious injury.

Any patient can be at risk of entrapment. However, there are some patients who are considered high risk for entrapment and the potential complications that arise from entrapment. Patients with conditions that cause confusion, restlessness or a lack of muscle control are at greater risk than the rest of the population. Ironically, it is often those patients for whom bed rails seem most necessary.

Bed rails create many problems for patients that are avoidable. In order to avoid the problems associated with bed rails it is important that patients and their families speak with nursing home staff about their concerns and about possible alternatives to bed rails.