Hospital beds feature adjustable side rails designed to enhance patient safety and support care providers. While these rails prevent falls, they must often be lowered for patient entry, exit, or specific medical procedures. Operating this equipment requires careful attention to the mechanism and the patient’s individual safety plan.
Identifying and Operating Different Rail Types
The process for lowering a hospital bed rail depends entirely on the specific locking mechanism, typically found near the rail’s ends or where it attaches to the bed frame. Common types include the spring-loaded button, the pull-release handle, and the foot-pedal release. Caregivers must first locate this release point to ensure positive control before disengaging the lock.
For a spring-loaded button mechanism, the operator must press the button inward, retracting a locking pin or plunger. Simultaneously, the rail must be held firmly to prevent it from dropping suddenly once the lock is released. The rail is then guided smoothly and slowly downward until it is flush with or beneath the mattress level. This controlled movement avoids startling the patient or causing mechanical damage.
Some full-length and older split-rail systems use a pull-release handle or lever, often located underneath the rail or on the outside of the frame. To lower this type, the handle must be pulled straight out or upward to disengage the internal locking mechanism. Once activated, the rail is lowered in a deliberate, slow motion until it reaches its lowest resting position. A gentle push or pull test confirms the rail is securely stored.
Safety Protocols: When Rails Must Remain Up
Bed rails primarily prevent patients from accidentally rolling out of bed, especially if they are sedated, confused, or experiencing uncontrolled movements. However, using rails poses a significant risk of entrapment, where a patient’s head or body gets caught in one of the seven recognized zones of the bed system. The U.S. Food and Drug Administration (FDA) identifies common entrapment points, such as the space between the rail and the mattress or within the rail bars themselves.
If a patient is capable of voluntarily getting out of bed but is prevented by the rails, the rails may be classified as a physical restraint. The use of restraints requires a comprehensive clinical assessment, a physician’s order, and documentation within the individualized care plan. Therefore, caregivers should not make an unsupervised decision to lower rails without consulting the healthcare provider responsible for the patient’s care plan.
The decision to keep rails up is based on assessing patient risk factors, including confusion, agitation, and lack of muscle control. For these patients, the rail acts as a necessary barrier to prevent a dangerous fall. Any adjustment to the rail position must align with the current medical order to maintain patient safety and comply with facility protocol.
Ensuring Overall Bed Safety After Adjustment
After lowering the bed rails for transfer or care, a comprehensive check of the entire bed environment is required to mitigate other fall risks. The first step involves ensuring the bed wheels are locked, which prevents the bed from shifting or rolling away as the patient attempts to enter or exit. The bed height must also be adjusted to a level optimal for the patient’s mobility, which is not always the lowest setting. An ideal height for sit-to-stand transitions allows the patient to place their feet flat on the floor with hips and knees bent slightly. Setting the bed too low increases postural demands and the risk of a fall during egress.
The integrity of the patient’s medical support system must be confirmed to prevent entanglement or accidental dislodgement of necessary lines. Intravenous (IV) lines, oxygen tubing, and monitoring wires must be checked to ensure they are secured and free from the path of the bed frame or wheels. The patient’s call light must also be placed securely within easy reach so the patient can summon assistance immediately after the caregiver leaves.