Bed rails are devices attached to the sides of a bed frame, typically made of metal or plastic, that can be raised or lowered. Originating in institutional settings, adjustable side rails appeared on hospital beds in Britain between 1815 and 1825 to enhance patient safety and medical care efficiency. The design became common in hospital environments to prevent patients from rolling out of bed and to assist nurses with patient handling. Over time, these products moved into long-term care facilities and home healthcare settings. Today, a diverse array of bed rail types are available for consumer use, centered on managing safety and mobility.
Primary Functions and Assistance
Bed rails primarily serve as a physical barrier to prevent patients from falling out of bed. This fall prevention is especially relevant for individuals with cognitive impairments, such as dementia, or those who are heavily medicated and prone to restlessness. The rail acts as a reminder of the bed’s perimeter, ensuring the person remains safely on the mattress.
Bed rails also function as a significant mobility aid for patients with limited movement. They provide a stable hand-hold for repositioning, such as turning or sitting up from a lying position. The sturdy structure offers support, helping individuals with physical limitations or poor balance transfer into and out of the bed with greater independence. In hospital environments, caregivers may use the rails to temporarily secure certain medical devices, such as drainage bags or IV lines.
Different Designs and Their Purposes
Full-Length Rails
These rails, often called enclosure rails, cover the entire length of the mattress. They are typically found in institutional settings for maximum fall prevention and containment. They are generally fixed to the frame and designed for patients at high risk of rolling out of bed.
Assist Rails and Transfer Handles
The Assist Rail or half-length rail is common in home settings, covering only a portion of the bed’s side. This shorter design is primarily a mobility aid, offering a stable point for the user to grasp when sitting up or transferring. Transfer Handles or grab bars are smaller, localized aids that attach to the bed frame or slide under the mattress. They are designed purely for stability and support during entry and exit.
Specialized Rails
Pediatric or Toddler Rails are lightweight and designed to prevent younger children from falling out of a standard bed. Unlike medical rails, they are not intended for use as a mobility device. Adjustable Bed Rails are versatile, allowing the length to be changed after installation. They often include support legs that extend to the floor for increased stability, making them popular for home care.
Understanding Major Safety Hazards
Despite their intended benefits, bed rails pose significant safety risks, particularly for elderly individuals and those with cognitive impairment. The most serious danger is entrapment, which occurs when a person’s body part—often the head, neck, or chest—becomes trapped in openings around the rail, mattress, or bed frame. Between 1985 and 2009, the U.S. Food and Drug Administration (FDA) received reports of over 800 incidents involving patients caught or trapped in beds with rails, resulting in nearly 500 deaths.
The FDA has identified seven specific zones of entrapment where this can happen. These zones include the space within the rail itself, the gap between the rail’s bottom and the mattress, and the openings at the ends of the rail near the headboard or footboard. Entrapment is most likely when the mattress does not fit tightly against the rail, when the mattress compresses, or when non-hospital rails are improperly fitted onto a standard home bed.
A paradoxical risk is the potential for increased injury severity from falls. A person who is confused or agitated may attempt to climb over a raised rail, resulting in a fall from a greater height than if the rail had not been present. Rails can also increase agitation and confusion in patients with delirium or dementia, as they may be perceived as a physical restraint. Regulatory warnings emphasize that rails should only be used when clinically necessary, and their use as a restraint without a medical order and frequent reassessment is strongly discouraged.
Safe Alternatives to Bed Rails
Several alternatives offer support or fall prevention without the high risk of entrapment or injury associated with bed rails. The use of low beds or ultra-low hospital beds is a common strategy, as they can be lowered close to the floor. This significantly minimizes the distance a person might fall, lessening the potential for severe injury.
Other effective safety measures include:
- Placing soft floor mats or crash mats alongside the bed to provide a cushioned surface and absorb impact should a fall occur.
- Using bed exit alarms and pressure-sensitive floor mats to alert caregivers when a person attempts to leave the bed, allowing for timely assistance.
- Mounting a trapeze bar above the bed, which offers a secure overhead grip for repositioning or sitting up without creating a side barrier.
- Using bed bumpers or bolsters, which are long foam wedges placed under the fitted sheet to create a soft, non-rigid barrier that prevents rolling off the edge.