What You Need to Know About Siderail Entrapment

When a patient is caught, trapped, or entangled in the siderails of a hospital bed, the consequences can be serious. Siderail entrapment can injure a patient’s head, neck, and chest and cause strangulation or suffocation. In some instances, siderail entrapment can result in death.

Since 1985, there have been over 800 siderail entrapment incidents reported to the U.S. Food and Drug Administration (FDA). From these 800 incidents, over 480 patients have died, and 138 were injured as a result of entrapment. Incidents occurred in openings within the siderails, between the rails and mattress, under siderails, between split rails, and between the rails and head/footboards.

Who is At Risk for Siderail Entrapment?

Though siderail entrapments most commonly affect elderly patients, there have been patients as young as 10 months old that have experienced entrapment incidences. As a result, patients of all ages are at risk for siderail entrapment, especially if the patient has been identified as having multiple risk factors.

A patient may be at greater risk if they are:

• Confused, agitated, or have memory issues
• Using sedatives or psychoactive drugs
• Experiencing uncontrolled body movements
• A fall risk
• Experiencing serious sleeping problems
• Incontinent
• Limited in mobility

Confining a patient to the bed using siderails can prevent patients from toileting or other routine activities, and can increase the likelihood of patient falls or entrapment. Siderail entrapments most commonly occur when a patient attempts to exit the hospital bed unassisted over, through, or around the siderail. This is a common issue for patients who are experiencing serious sleeping problems or who are incontinent.

Patients with uncontrolled body movements and with limited mobility, or who are confused may find themselves involuntarily trapped in the siderails. Without nurse assistance, the consequences can be fatal.

FDA Entrapment Zones

The FDA has received reports of siderail entrapment in health care facilities for over 20 years. In response to these reports, the FDA partnered with the U.S. Department of Veterans Affairs, Health Canada’s Medical Devices Bureau and other health care representatives and patient safety groups to address the issue of siderail entrapment.

From the study, the FDA identified 7 potential entrapment zones:

• Zone 1 – Within the rail
• Zone 2 – Under the rail, between the rail supports or next to a single rail support
• Zone 3 – Between the rail and the mattress
• Zone 4 – Under the rail at the ends of the rail
• Zone 5 – Between split bed rails
• Zone 6 – Between the end of the rail and the side edge of the head/footboard
• Zone 7 – Between the head/footboard and the end of the mattress

How Can Your Facility Prevent Siderail Entrapment?

New Hospital Beds

The majority of newly manufactured hospital beds will meet the FDA guidelines for Zones 1, 2, 3 and 4.  Currently there are not guidelines for Zones 5-7 because they are not monitored. This may change in the future and it is important to purchase beds that consider these Zones in their bedrail design. To ensure your new beds are not at risk for entrapment, ask for a statement or letter from the bed manufacturer certifying which entrapment zones their beds pass. 

Legacy Hospital Beds

For legacy hospital beds, minimizing entrapment risks should be a health care facility’s top priority.  Ensure that the spaces between the siderails, head/footboard, and mattress prevent lodging and entrapment.  The space between split siderails should limit the event of wedging, which can cause injury or harm to the patient’s head, neck, and chest.

If your facility uses legacy hospital beds with bar siderails, ensure that the bars are closely spaced to prevent a patient’s head and extremities from becoming caught. The FDA recommends a width of 4 ¾ inches or less between bar rails to limit head entrapment. Using a hospital bed with filled siderails for high-risk patients can prevent the entrapment of extremities like the hands and feet within the siderail.

All Hospital Beds

Continually evaluating your hospital bed can limit the occurrence of siderail entrapment. Special consideration should be given to evaluating siderail latches to ensure that siderails do not fall or loosen and cause serious harm to patients and create entrapment risks.

Health care facilities should also take into consideration mattress compressibility, which can change throughout the life of the mattress and create an entrapment risk. When replacing a mattress, be sure to check the gap between the mattress and the siderail. Facilities should ensure that the space between the siderail and the mattress prevents a patient from falling into the gap and becoming trapped.

HBSW Testing Kit

The best way to ensure that your hospital bed meets the Entrapment Guidelines is to test each bed using an HBSW testing kit.  The HBSW Bed Safety Entrapment Kit is available through National Safety Technologies at http://www.nst-usa.com.

It is up to the healthcare facility to test their beds against the Entrapment Guidelines.  Determining who should measure beds and mitigate identified risks isn’t always an easy task. Some facilities have assigned the bed assessment task to physical plant, nursing, or clinical/biomedical engineering staff. The implementation, scheduling, and funding of mitigating remedies may be jointly addressed by a committee with representatives of risk management, engineering, purchasing, materials management, and the safety committee.

Alternatives to Siderails

Though siderails are commonly used to prevent patient falls from bed, patients who attempt to climb over raised siderails are at a greater risk of injury, including entrapment, fractures, sprains, and head trauma. To minimize the risk of siderail entrapment, health care facilities should consider alternatives to siderails.

Using a low hospital bed can accomplish patient fall prevention goals without the use of restrictive high siderails that confine patients to the bed. Keeping the bed in the lowest position can allow ambulatory patients to safely exit the bed without climbing over rails and risking entrapment. Placing floor fall pads or mats next to the hospital bed can also be used for patients at risk of falls.

Using multi-zone bed-exit alarms can alert nurses to changes in a patient’s positioning and limit the occurrence of falls with nurse intervention. Bed-exit alarms can also be used in conjunction with siderails to alert nurses when medicated or low mobility patients have moved positioning and may be entrapped in the siderail.

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CHG Hospital Beds specializes in low hospital beds that are designed to prevent patient falls and related injuries within acute care environments. We are focused on patient and nurse safety and deliver innovative solutions to meet the needs of our customers.