POLICY FOR THE USE OF BEDRAILS AND BEDRAIL COVERS

POLICY FOR THE USE OF BEDRAILS AND BEDRAIL COVERS N.B. Staff should be discouraged from printing this document. This is to avoid the risk of out of date printed versions of the document. The Intranet should be referred to for the current version of the document.

Contents: 1 INTRODUCTION... 2 2 POLICY STATEMENT... 3 3 PURPOSE... 3 4 DEFINITIONS... 4 5 RESPONSIBILITIES WITHIN THE ORGANISATION... 6 5.1 DIVISIONAL / SENIOR NURSE... 6 5.2 WARD/DEPARTMENT MANAGERS/TEAM LEADERS... 5 5.3 ALL STAFF INVOLVED IN PATIENT CARE... 7 6 RISK ASSESSMENT... 6 7 BEDRAIL COVERS... 7 8 MAINTENANCE & DECONTAMINATION... 7 9 COMMUNITY... 8 10 USE OF BEDRAILS FOR CHILDREN AND YOUNG PEOPLE... 9 11 REPORTING OF INCIDENTS... 11 12 Review of Policy... 11 13 SUPPORTING INFORMATION... 11 14 REFERENCES... 12 APPENDIX 1 - Alternative solutions to provision of bedrails... 13 1

1 INTRODUCTION 1.1 Aneurin Bevan Health Board (ABHB) aims to take all reasonable steps to ensure the safety and independence of its patients, and respect the rights of patients to make their own decisions about their care. 1.2 Bed rails, the preferred title for cot sides and safety sides, are equipment that should be used to reduce the risk of a patient accidentally slipping, sliding, falling or rolling from a bed or trolley. Using bed rails to prevent the patient from leaving their bed or trolley and in certain situations could be considered as a restraint, (NPSA 2007) (MHRA 2006) (MDA 1997) (MDA 1999) (MDA 2001), therefore bedrails need to be used with caution and reference made to Deprivation of Liberty Legislation and guidance when appropriate. Restraint is defined as the, restricting movement or liberty or the intentional restriction of a person s voluntary movement or behaviour. An alternative plain English definition is stopping a person doing something they appear to want to do, (RCN 2008). 1.3 Although bed rails are predominantly designed to prevent falling from a bed or trolley, there is evidence to suggest that the incorrect use of bed rails may constitute a hazard. Accident data shows that bed rails do not prevent falls and in some instances, may introduce other risks (HSE 2012). Examples include: rolling over the top of the rail climbing over the rail climbing over the footboard violently shaking and dislodging rails violent contact with bed rails Bed rails will not prevent a patient leaving their bed and should not be used for this purpose. Bed rails are also not intended as a moving and handling aid. 2

1.4 Patients in hospital and within community settings may be at risk of falling from a bed or trolley for many reasons including poor mobility, dementia or delirium, visual impairments, disabilities including learning disabilities and the effects of medication or treatment. 1.5 The guidance acknowledges that bed rail covers may be needed to offer protection in relation to tissue viability issues, entrapment and the allocation/prescription of bed rail covers requires assessment. However the use of bedrails covers can carry their own inherent risks and their use should also be subject to risk assessment 1.6 Bed rails are not appropriate for all patients, and using bed rails also involves risks. Therefore lowering of beds and alternative methods must be considered (see appendix 1). 2 POLICY STATEMENT This Policy sets out the Board s approach to the safe and effective use of integral bedrails which are a component for the profiling beds and trolleys currently used extensively in hospital setting and removable bed rails used with beds within in the community setting. This approach will promote the dignity, privacy and human rights of all individuals involved to promote equality. This Policy, to which all staff involved with patient safety should be aware of, is to be used in conjunction with other Aneurin Bevan Health Board policies that can be found on the intranet and include: 3 PURPOSE Prevention and Management of Falls Policy Management of Medical equipment and Devices Policy Infection Prevention and Control Policy Deprivation of Liberty Safeguards, code of practice Policy and Procedure Occupational Health and Safety Policy Transfer of Patients between Hospital Wards and Departments The policy aims to:- to provide guidance for the use of bed rails 3

to reduce the risk of harm to patients due to falling from beds/trolleys or entrapment in bed rails ensure compliance with Medicines and Healthcare Related Products Agency (MRHA), IEC601-2-38 (International Standard for Electrically Operated hospital beds) and National Patient Safety Agency (NPSA) advice ensure bedrails and where appropriate, bed rail covers, are fit for purpose. 4 DEFINITIONS 4.1 Integral Bed rails Bedrails which are permanently fixed to the structure of the bed, and applies to most hospital beds and trolleys within ABHB. 4.2 Third party bedrails Bedrails that are attached when required and are found on the Contoura, Minuet 1, 2 and the Etude in community settings. 4.3 Bedrail Covers (also known as bumpers) These are a padded air permeable accessory or enveloping cover that are primarily used to prevent impact injuries but can also reduce the potential risk of limb entrapment when securely affixed to the bed, trolley or rail. In some instances these can themselves become a hazard and introduce entrapment and suffocation risks if they are able to move or compress. 4.4 Inflatable Bed Sides These are air filled bedrails. For some children s systems inflatable bed sides house the mattress in its own pocket or compartment, a feature which reduces entrapment risk between the mattress and bed sides. 4.5 Entrapment To be restrained or restricted. In this context entrapment occurs when limbs, head or other body parts becomes trapped between the mattress or bed rail cover, bed rail and bed/trolley frame or between components of the bed rail itself. 4

5 RESPONSIBILITIES WITHIN THE ORGANISATION 5.1 DIVISIONAL/ SENIOR NURSE The Divisional / Senior Nurse is responsible for ensuring that: 5.1.1 services provided within the Health Board and its composite areas are fit for purpose, providing safe and effective care which is patient centred and evidenced based ward Managers/Team Leaders are aware of the policy and their role and responsibilities in its implementation. 5.1.2 the cause of incidents, in relation to the use of bed rails, is investigated and actions/recommendations are acted upon to prevent recurrence. 5.2 WARD/DEPARTMENT MANAGERS/TEAM LEADERS Ward Managers in adult inpatient areas and Team Leaders in the Community are responsible for adhering to this policy. They are also responsible for ensuring staff involved with patient care are suitably trained and competent in the use of the bed rails and bed rail covers. A training package can be found on ABHB intranet courses, education and learning/health & safety training courses/safe use of bedrails. (N.B. with the exception of Section 6, selecting and fitting bed rails, all sections of this training is relevant). 5.2.1 Suitable and sufficient bed rail/bed rail covers risk assessments are undertaken. An example risk assessment is available on the H&S intranet page. 5.2.2 Particular care should be taken in the assessment of young adolescent patients, placed on adult wards and requiring bedrails. (see section 9) 5.2.3 Although the majority of the profiling beds within both hospitals and community can be reduced to a much lower level than the previous beds, hiring of ultralow beds may need to be considered in very high risk cases. 5.2.4 Staff to be made aware of policy. 5

5.3 ALL STAFF INVOLVED IN PATIENT CARE All Healthcare professionals, including students and temporary staff, using bedrails or bed rail covers, either directly or indirectly, are responsible for ensuring they have the appropriate knowledge to do so via training package provided. All staff should abide by this policy to ensure bedrails and bed rail covers are used safely and effectively. The risk assessment must be reviewed if there are any changes e.g. if the patient is distressed by the bedrails or bed rail covers, is in an unsafe position, or is attempting to climb over the bed rails. Bed rails SHOULD BE lowered during the moving and handling of the patient or when any personal care is undertaken and returned to a fixed upright position when these procedures are completed. It is the responsibility of the staff lowering the bedrails to ensure they are returned to the upright position. 6 RISK ASSESSMENT 6.1 All types of bed rails/bed rail covers should only be used when a risk assessment, (example risk assessment accessible via health and Safety intranet page) has identified that they might prevent harm to the patient. Whenever possible the patient and patient carer will participate in the risk assessment and the decision communicated to all involved 6.2 A specific falls risk assessment will identify additional factors that may need to be taken into consideration. 6.3 Generally bed rails should not be used if the patient is agile enough, disorientated and/or deemed likely to climb over them. 6.4 In hospital settings, bed rails must be used if the patient is being transported on their bed; or is recovering from anaesthetic or sedation; under constant observation and when the benefit of using them is assessed as outweighing potential risk to the patient. 6.5 The behaviour of individual patients can never be completely predictable and ABHB staff will be supported when decisions 6

are made by staff caring directly for the individual in accordance with this policy. The risk assessment should be recorded in the patients nursing notes / unified assessment documentation and should be: reviewed at regular intervals, as the patients condition changes as part of ongoing clinical observations if there is any change in the mattress, or if an overlay mattress is used 7 BEDRAIL COVERS If there is a risk of the patient trapping their head, body or limbs between the bedrails then specifically designed padded accessories must be properly applied. When they are not available this must be documented and an incident recorded on Datix and other action to be taken to reduce the risk to its lowest level. Bed rail covers MUST NOT exceed the length of the bedrail as this will present an entrapment risk Prior to use staff should inspect for any signs of damage, faults or cracks and, any identified as defective, must be reported for repair immediately (see maintenance 7.2). 8 MAINTENANCE & DECONTAMINATION 8.1 All bed rails, including third party bedrails, and bed rail covers should be visually checked at every use and any faults detected and reported to Arjo Huntleigh or trolley suppliers in line with ABHB Management of Medical Equipment and Devices Policy. 8.2 The servicing and maintenance of beds/bedrails and bedrail covers are undertaken annually by Arjo Huntleigh as part of a programme of planned maintenance in both community and hospital sites. The bed rails are inspected within the bed service in both areas 8.3 Bedrails and bed rail covers should only be used and maintained in line with the manufacturer s instructions for use. 7

8.4 Bed rail covers must be decontaminated before, during and after use according to the manufacturers instruction and as part of ABHB Infection Prevention, Control Policy. 9 COMMUNITY The previous sections of this policy are all applicable to ABHB Community staff if there is a healthcare need and the patient is receiving care from health with the following additions. 9.1 Following appropriate risk assessment bed rails should be requested by ABHB community request process via the Health Board Bed Depot. Bed rail covers are not stock items and should be requested via line managers when appropriate. 9.2 If the need for bedrail is identified by ABHB staff for equipment not provided by health the matter should be referred to the equipment provider for assessment. 9.3 Fixation of third party bed rails are applied by engineers delivering the beds and the following dimensions must be guaranteed:- The gap between the top end of the bedrail and the head of the bed should be less than 60mm or more than 250mm. (From April 2013 equal or less than 60mm only) The gap between the bottom end of the bedrail and the foot of the bed should be no more than 250mm. (From April 2013 equal or less than 60mm only or greater than 318mm) The top of the bed rails must be more than 220mm above the top of the uncompressed mattress in at least 50% of the length of the mattress platform, and with the bed base in a flat position No gap between the side of the mattress and the bed rail The dimensions and gaps comply with current regulations There are instructions that can be issued with the bed rails Consider gap between top of compressed mattress and bottom rail 8

9.4 When a patient has been reviewed and no longer requires third party bed rails, this information should be recorded in the patients nursing notes / unified assessment document and staff informed. The team leader/staff member should organise their removal, collection and decontamination via the Health Board Bed Depot 10 USE OF BEDRAILS FOR CHILDREN AND YOUNG PEOPLE BS.EN.IEC 60601-2-52:2010 (page 52), recognises that the definition of the terms adult and child are based on physical characteristics. The dimensional requirements of this particular standard are based on anthropometric data based on patients ranging in physical size from a 146 cm tall female to a 185 cm tall male. For beds intended for use with patients outside this range, all dimensional characteristics in this particular standard should be adjusted accordingly. Most bed rails are designed to be used only with adults and adolescents. A risk assessment should always be carried out on the suitability of the bed rail for the individual child or small adult, as bar spacing and other gaps (e.g. between the bed base/mattress/rails) will need to be reduced. When risk assessing bed rails for children, assess their compatibility with the size of the individual child and the specific circumstances for use (MHRA 2006). Bed rails are integral on ABHB paediatric beds and they are colour coded on the foot boards for identification purposes. There are NO published standards on bed rails for children but there are other standards addressing the entrapment risk (BS EN 12182) which suggests that the maximum space to avoid entrapment of children s heads in static equipment is 60mm. Consideration should also be given to the suitability of the bed. Many of the alternatives to bed rails can be used with children. (See appendix 1) 10.1 Bed rails should not be used for those children and young people who are: 9

Assessed as being at risk of becoming entrapped by the bed rails Assessed as being at minimal risk of falling and therefore identified as not requiring bed rails. 10.2 When purchasing or making assessments of bed rails for children in the community, seek guidance on suitable rails via Continuing Care Occupational Therapy department. 10.3 Inflatable bed sides are not generally adjustable and may need to be used with a mattress of particular dimensions. When carrying out an assessment on the risk of entrapment, the elasticity (compression and extension) of the material should be taken into account, as the inflatable rails may change shape when the bed occupant leans against them. 10.4 Use of inflatable bed sides on children s beds Inflatable bed sides are not generally adjustable and may need to be used with a mattress of particular dimensions. When carrying out an assessment on the risk of entrapment, the elasticity (compression and extension) of the material should be taken into account, as the inflatable rails may change shape when the bed occupant leans against them. MHRA DB2006(06) December 2006 14/30 Some inflatable bed sides house the mattress in its own pocket or compartment, a feature which greatly reduces entrapment risks between the mattress and the side walls. Inflatable bed sides need to be fully inflated to be effective. They may deflate over time so regular checks should be made to ensure this has not happened. Care should be taken to use the inflatable bed sides as instructed by the manufacturer. If a cot is used, the cot sides are permanently fixed, and must be used when the child is asleep, or unattended by an adult. 10.5 Cot rail covers must not be used on cots if the child is sleeping or unattended by an adult due to risk of suffocation 10

11 REPORTING OF INCIDENTS 11.1 Any injury caused either to a patient or a member of staff, due to use of bed rails/bed rail covers should be reported in line with the Health Boards Datix incident reporting procedure. 11.2 Any serious untoward incident due to the use of bed rails should be reported to Health and Safety at the earliest opportunity and immediate action taken to avoid a reoccurrence. 11.3 Defective equipment should be removed from service immediately and reported via the Health Boards Datix incident reporting procedure. It should be retained for possible independent testing and MUST NOT be returned to the manufacturer without prior consent from the Risk Manager for Medical Devices. 12 REVIEW OF POLICY 12.1 The safe use of bedrails and bedrail covers policy will be reviewed every 3 years and in accordance with the following and on an as and when required basis: Legislative changes Good practice guidance Case law Significant incidences reported Changes to organisational infrastructure. 13 SUPPORTING INFORMATION ABHB Occupational Health & Safety Policy Datix Web Incident Reporting Policy IEC601-2-38 International Standards for Electrically Operated Hospital Beds (1996) NAEP - National Association of Equipment Providers Bed Rail Provision, Guidance for Assessment and Provision, Clinical & Prescriber Support, Special Interest Group, Issue 1: June 2011 11

14 REFERENCES BS.EN.IEC 60601-2-52:2010 - British Standard Requirement for Basic Safety and essential performance of medical beds Health and Safety Executive (HSE) 20012 www.hse.gov.uk/healthservices/bed-rails.htm MHRA Device Bulletin (Ref:- DB 2006(06)) Medicines and Healthcare Products Regulatory Agency (2006) National Patient Agency (2007) www.npsa.nhs.uk EQUALITY IMPACT ASSESSMENT This policy has undergone an equality impact assessment screening process using the toolkit designed by the NHS Centre Equality & Human Rights. Details of the screening process for this guidance are available from the policy owner. 12

APPENDICES Examples APPENDIX 1 - Alternative solutions to provision of bedrails Inflatable systems Side wedges Extra low, variable height bed Extra low, variable height bed with crash mats Internal foam surrounds Sensory/motion/pressure alarms NB - all of the above require risk assessment taking into consideration the following factors: Re enablement/rehabilitation take into consideration the needs of the patient Suitability of existing bed for accessories Condition and type of mattress e.g. extra dense foam Previous falls related to transfers from bed Patient s wishes Compatibility of combinations of equipment e.g. mattress systems/mobile hoist/standing aid or mattress elevator/pillow lifter (community care) Informal carers and family members understanding use of alternatives. Any manual handling difficulties using the above equipment. 13