Side-Rail Assessments in Assisted Living

During in-person assisted living surveys, the Minnesota Department of Health (MDH) has increased its focus on side rails and other bed-attached assistive devices, often known as bedside rails, safety rails, grab bars, or assist bars.

Many communities are cited for lack of a side-rail/bed rail assessment or an incomplete assessment. 

In 2006, the FDA released Hospital Bed System Dimensional and Assessment Guidance to Reduce Entrapment to provide information regarding the safe use of these assistive devices. Following this information and standard of care, any bedrail or assistive device like a grab bar, requires an assessment to determine whether there is a risk of entrapment or other safety concerns. The assessment should include information on the side rail measurements. A diagram in the FDA information depicts entrapment zones of a traditional hospital bed with two half-rails installed. We do not often see this type of bed and bed rail combination in assisted living. This often leads to questions about how to measure other types of rails.

There are good descriptions of the zones, and these descriptions should be used to determine locations where the side rail or grab bar should be measured and documented. In addition to the measurements and side rail assessment, the resident / responsible party should receive information on side rails, including safety risks. The FDA created a brochure for this purpose widely used in senior services. Documentation of this information receipt and discussion should also be in the record. A quick list of what's required by nursing staff if a resident has side rails in assisted living includes:

• Side rail assessment for entrapment, including measurements. Things to consider including in a side rail assessment:
  • Resident preference
  • Medical conditions
  • Rationale for use
  • Medical symptoms
  • Medications
  • Risk for injury – previous incidents
  • Mobility / strength
  • Cognition
  • Alternatives to bed rails
  • Whether the bed rail function as a restraint
• Documentation of resident / responsible party education, including their understanding of the side rail risks
• Documentation of resident / responsible party receipt of bed rail pamphlet

Most organizations have side rail assessments that are standard. Your electronic medical record provider may have one if you don't have a side rail assessment.

For questions on side rails, please contact Kari Everson.

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