PROCEDURE FOR THE SAFE USE OF BED RAILS AND BED GRAB HANDLES

PROCEDURE FOR THE SAFE USE OF BED RAILS AND BED GRAB HANDLES Issue History Aug 07 Issue Version Two Purpose of Issue/Description of Change To promote safe and effective use of bed rails and bed grab handles for adult patients across Provider Services Planned Review Date 2014 Named Responsible Officer:- Approved by Date Service Improvement Unit Clinical Policies and Procedures Group January 2011 Multi Disciplinary Procedure:- CP40 Impact Assessment Screening Complete Date: December 2010 Full Impact Assessment Required Y/N UNLESS THIS VERSION HAS BEEN TAKEN DIRECTLY FROM THE PROVIDER SERVICES WEB SITE THERE IS NO ASSURANCE THIS IS THE CORRECT VERSION

INTRODUCTION Bed rails are used in care environments to minimise the risk of bed occupants falling out of bed and injuring themselves. They are not designed or intended to limit freedom of people by preventing them from leaving their beds voluntary; nor are they intended to restrain people. Bed rails should be used only after a full, documented risk assessment has been carried out and the outcome of the assessment confirms that the provision of bed rails will contribute to the safe management and care of the patient. The function of bed grab handles (also known as bed leavers or bed sticks) is to assist the bed occupant s movement in bed and/or to support transfers on/off a bed. Bed grab handles are not designed to prevent patients falling from their beds and must not be introduced for this purpose. PROCEDURE AIMS NHS Wirral is committed to compliance with its statutory responsibilities and following National Patient Safety Agency recommendations and Medicines and Healthcare Products Regulatory Agency (MHRA) guidance to ensure the safe and effective use of bed rails and bed grab handles. The purpose of the procedure is to ensure that the risks and benefits associated with the provision of the equipment are thoroughly and carefully assessed the potential for harm to patients caused by falling from beds or becoming entrapped in the equipment is effectively managed staff and patients are supported in making decisions concerning the provision of bedrail and bed grab handle equipment and promoting safe individualised care. PROCEDURE OUTCOME All appropriately trained ordering officer staff will follow best practice in the provision and use of bed rail and bed grab handle equipment. Only nominated, trained staff will be eligible to carry out a bed rail risk assessment and order and fit that equipment where the assessment/reassessment findings indicate that this is the risk management strategy to be followed to promote patient safety. TARGET GROUP Bed Rail Equipment minated, trained ordering officers from community nursing, physiotherapy and occupational therapy disciplines employed by NHS Wirral. In addition staff from other organisations who have Community Equipment Service (CES) ordering rights and are eligible to requisition bed rail equipment from the CES will be expected to work in partnership with their NHS Wirral Community based colleagues to promote patient safety. 2

Bed Grab Handle Equipment all ordering officers from community nursing, physiotherapy and occupational therapy disciplines employed by NHS Wirral. In addition staff from other organisations who have CES ordering rights and are eligible to requisition this equipment from the CES. TRAINING Provider services nominated staff must attend training in the assessment, safe use and safe fitting of bed rail equipment. The training will include bed grab handle equipment, coordinated by the Service Improvement Unit. Staff will be expected to maintain their knowledge and skills by attending update training every three years or more regularly if this is identified as an individual learning objective. Service managers are responsible for ensuring staff attend training. ASSESSMENT PROCESS Bed rails - The MHRA have identified that a comprehensive risk assessment taking account of the relationship between the physical characteristics of the bed occupant, the individual clinical presentation and any equipment used in the patient s care must be conducted to determine whether bed rails are indicated. The assessment process will ensure that risks are adequately identified, controlled and exposure to potential for entrapment and injury from bed rails (MHRA 2006) is effectively managed. Those at greatest risk include people with:- communication impairment confusion dementia impaired or restricted mobility repetitive or involuntary movements physical characteristics including very small or very large head Assessments must be thorough and documented (see form appendix 1), signed by the assessor and dated. Bed rails are a safety device and when used approriately, following a detailed assessment, can improve patient safety. Inappropriate provision and use of bed rail equipment may compromise patient safety and/or be interpreted as a form of restraint or abuse, which can result in civil or criminal prosecution. Bed Grab Handles - It is essential to carry out a risk assessment, using the generic HS ( (2) risk assessment form and filed in the patients health records to ensure that the use of the bed grab handle meets the identified needs and does not introduce any entrapment or other unacceptable risks. Assessment should establish that the bed occupant has understanding and sufficient head, trunk and upper limb strength and coordination to use the equipment safely. The compatibility of the equipment with the type of bed on which it is to be used together with its compatibility with any other equipment used to support bedcare must be considered during the assessment. The assessment should also take account of the user/carer ability to safely remove and refit the equipment as required/necessary. In the event that the assessment indicates the supply of the 3

equipment is appropriate, meets the identified needs and does not introduce unacceptable risk, the equipment ordered must have a safe working load (SWL) compatible with the the bed occupant s weight. Bed grab handles must not be used in combination with bed rails as this can result in a greater risk of user injury. REASSESSMENT Bed rails and bed grab handles are an entrapment risk and must always be used with care. Reassessment is the responsibility of the ordering officer. All reassessments must be documented and added to the patient s treatment record. minated trained ordering officers are required to review the suitability of bed rails for the patients on their caseloads at regular intervals (every 12 months) and at any time when there is any change in the bed occupant s presentation/condition or physical characteristics, and/or when there is the introduction, removal or replacement of bed related equipment e.g. mattress change, bedrail replacement. ADDITIONAL ORDERING OFFICER RESPONSIBILITIES It is the responsibility of the ordering officer to ensure that the equipment is fitted safely and appropriately to the bed and is fit for purpose. There is a responsibility to ensure the patient and/or the carers understand how to use the equipment safely, have an understanding of the risks associated with the inappropriate use of the equipment and know who to contact in the event of any concerns or faults being detected. minated trained ordering officers must only fit bed rails to the bed when there is sight of evidence of a completed current bed rails risk assessment document recommending their provision. The Bed Rails Equipment Fitting form (see appendix 2) must be completed, signed and dated and added to the patient s treatment record when the fitting activity is undertaken. CES staff are not responsible for fitting bed rails to the bed and this task must not be delagated to them or anyone else who is not a nominated trained ordering officer. Private care agencies are required to follow their own organisational guidance regarding the safe use of bed rails and grab handles. 4

SAFE USE OF BED RAILS PROCEDURE Introduce yourself and any colleagues involved at the contact. Verbally confirm the identity of the patient by asking for their full name and date of birth. If patient unable to confirm, check identity with family/ carer. To gain co-operation RATIONALE To avoid mistaken identity. Explain the assessment purpose and process. Conduct the assessment following the risk information detailed on the Safe Use of Bed Rail Risk Assessment Form (See appendix 1). Document and sign form indicating supply decision and secure in patient s treatment record. Discuss the assessment outcome with the bed occupant/carers. Select the appropriate bed rails to be ordered from the Community Equipment Service for the patient, based on the assessment findings and recommendations. NB Orders for bed rails which are to be fitted to a CES supplied bed in situ must include the asset number of that bed. Asset numbers are marked on the frame of the bed and commence C004 followed by a unique series of numbers. To secure engagement, cooperation and patient/carer involvement. To ensure there is clarity and understanding of the need to manage risks associated with falling, slipping, sliding or rolling from bed; To confirm the approach to providing safe care. To establish how suitability for the provision of bedrails is determined. To comply with National Patient safety Agency (NPSA) guidelines 2007. Risk assessment is a legal requirement designed to identify and effectively control risks. Evidence that alternative strategies have been considered and their effectiveness evaluated. Confirms all risks have been considered and provides evidence process has been followed. It demonstrates that any risks from using bed rails are balanced against the anticipated benefits to the user. To ensure patient/carer s understanding and secure compliance. To ensure the most appropriate bed rail is selected and takes account of the clinical needs of the patient, the type of bed in use, other equipment in use and the care environment. To ensure the bed rails supplied and the bed in situ are compatible with one another. 5

PROCEDURE If bed rails are to be assessed for use with a bed other than a CES provided bed, the assessor must discuss the assessment findings and provision of the equipment with their manager before the equipment can be confirmed for issue. The organisation requires the manager to sign the assessment document to support the assessment outcome due to the level of high risk when using this type of bed rail. Safe fitting: Bed rails must not be fitted without evidence/sight of current assessment document. Fit the bed rails, complete the Bed Rails Equipment Fitting form (see appendix 2). Sign and date document. NB CES staff are not responsible for fitting bed rails equipment. Provide patient and/or carer with information about safe use of equipment, risk issues consequent to inappropriate use and contact details for seeking help. Ensure completed fitting documentation is securely included in the patient s treatment records. CONSENT RATIONALE The use of universal bed rails carries a significantly higher risk of injury for the bed occupant. Evidence of thorough assessment, reasoning and strict risk management approach to a high risk situation. To ensure a bed rails assessment has been conducted and the safety of the patient is being managed. To confirm the bed rails are checked, positioned correctly, fitted securely and functioning safely. To support the safety of the bed occupant and others. To ensure the equipment remains correctly positioned, secured and used correctly. To comply with NHS Wirral Health Record Keeping Policy. All NHS Wirral staff will take reasonable steps to ensure the safety and independence of patients and respect their rights to make their own decisions about their care. This empowers patients to make their own health choices, whilst understanding the benefits and risks. Where the risk assessment indications are at variance with the wishes of the patient this must be raised by the assessor with the manager and the considerations and their outcomes must be documented. In cases where the patient is not able to give informed consent, NHS Wirral Consent Form 4 needs to be completed to demonstrate that there has been an assessment to determine whether the supply of the equipment is in the best interests of the patient. INCIDENT REPORTING SYSTEM Staff must complete an NHS Wirral incident form in any circumstances where the provision of bed rails or bed grab handle equipment has resulted in injury to patients and/or carers or has raised any concerns for safety and must include 6

near misses where the potential for injury has been identified. This also applies to any observed inappropriate use of bed rails or bed grab handle equipment in other care settings where the safety of the bed occupant is identified as being adversely compromised by the use of the equipment. RESPONSIBILITY FOR SHARING INCIDENT REPORTS It is the responsibity of the team leader to ensure there is compliance with the NHS Wirral Incident Reporting policy and to report incidents involving the equipment to the National Patient Safety Agency, the Medicines and Healthcare Products Regulatory Agency and the Health and Safety Executive as appropriate using the appropriate reporting systems and documentation REFERENCES Medicines and Healthcare Products Regulatory Agency (MHRA 2006) Device Bulletin. Safe Use of Bed Rails - December. DB2006(06). Medicines and Healthcare Products Regulatory Agency (MHRA 2007) Bed rails and grab handles - 1 st February. (MDA /2007/009) National Patient Safety Agency (2007) Safer Practice tice 17. Using bedrails safely and effectively - February. BIBLIOGRAPHY National Patient Safety Agency (2007) Resources for reviewing or developing a bedrail policy - March. 7

Appendix 1 Bed Rails Risk Assessment Form Client Full Name: Assessment Date: Date of Birth: Case note / NHS : Section 1 - Overview Is the client likely to fall from the bed? Have alternative bed safety management methods been considered? Have alternative falls management strategies been considered? Are bed rails the preferred equipment option for the client s needs? Section 1 no answers indicate that the client is not appropriate for provision of bed rails. Section 2 Bed Occupant(s) Factors Does the bed occupant have any of the following:- Restlessness or confusion at any time? Communication impairment? Impaired/restricted mobility? Involuntary or repetitive movements? Epilepsy? Tissue viability impairment? Does the physical build/characteristics of the bed occupant increase the risk of entrapment in gaps between the bed rails and bed equipment combination due to the occupant s:- HEAD size? BODY size? Is the bed occupant a child or small adult? Is the bed occupant likely to:- get out of bed unsupervised for any reason? climb over the bed rails to get out of bed? Could the use of bed rails:- increase agitation or confusion? increase risk of injury? Are bed rails being used as a method of restraint? Section 2 yes answers may indicate that an alternative bed management method is more appropriate Section 3 Equipment Factors Type of bed to which bed rails are to be fitted Divan Single Divan Double CES Bed Number of bed occupants including the client Where the bed is in situ are all components of the bed to which the bed N N/A rails are to be fitted in good condition? o Is the mattress in good condition and the correct size and shape to fit N N/A the bed? o Section 3 no answers may indicate that alternative bed management methods are more appropriate. Section 4 Assessment Recommendations Bed rail recommended Bed rail not recommended Additional Comments/Risk Assessment tes overleaf... ASSESSOR NAME:- Print Signed Designation Bed rails are an entrapment risk and must always be used with care. Assessments must be carried out before use and then reviewed and recorded when there is any change in the bed occupant s condition, replacement of any part of the equipment combination and regularly during the period of bed rail use. NHS Wirral Provider Services January 2011 8/9

Appendix 2 Bed Rails Equipment Fitting Bed rails are an entrapment risk and must only be fitted when a thorough risk assessment has been undertaken by a nominated trained ordering officer. Client Full Name: Date of Birth: Original Fitting Date: Risk Assessment Date: Case note /NHS.: Fit Review Date: Section 1 Equipment Checks If fit review are bed rails still in situ on bed? Are all components of the bed to which the bed rails are to be fitted in good condition? Is the bed rail equipment compatible with the bed to be used? Is the bed rail in a safe and maintained condition? Do the bed rails function correctly? Do the fittings allow the bed rail equipment to be fitted to the bed securely, so there is no excessive movement? Does the mattress allow the bed rail equipment to be fitted to the bed securely, so there is no excessive movement? If bed rail bumpers are fitted are they in good condition and securely in place? N/A answers indicate inadequately controlled risk Section 2 Bed Occupant(s) Checks Bed Occupied Is the bed occupant s HEAD or BODY large enough not to pass between the bars of the bed rails? through any gap between the bed rails and the side of the mattress through the gap between the lower bed rail bar and the mattress, allowing for compression of the mattress at its edge? If the bed occupant is a small adult or a child does the element spacing fall within the range 45mm-78mm? N/A Are the gaps between the bed rail bars less than 120mm? Are the headboard/footboard to bed rail end gaps less than 60mm or greater than 250mm Are the bed rails high enough to keep the bed occupant safe taking into account mattress thickness or additional overlay? answers indicate inadequately controlled risk Section 3 User Information Equipment information supplied to bed occupant/carer Safe use of equipment demonstrated Provision of contact details in event of concern Risk factors discussed with bed occupant/carer answers indicate inadequately controlled risk Section 4 Fitting & Safe Use Confirmation Fitter (print) (signed) Designation PROCEDURE FOR THE SAFE USE NHS OF Wirral BED RAILS Provider AND Services BED GRAB January HANDLES 2011 FOR ADULTS IN THE COMMUNITY 9/9