The Safety Risks Posed by Restraints

Empty hospital bed

Office of the Chief Coroner says bed rails should only be used after a full risk assessment

An expert committee of the Chief Coroner’s office is highlighting the safety risks posed by restraints after the deaths of two patients in retirement homes.

The first patient death investigated by the Geriatric and Long-Term Care Review Committee was an 88-year-old man who died from asphyxia secondary to obstruction of nares as a result of becoming caught in a circular “Halo safety ring” extension on the side of his bed. It is believed that the patient got his chin caught in the circle of the Halo and his neck was compressed between the mattress and the ring, with his body on the floor. The combination of neck compression and obstruction of his nares as a result of a previous surgery resulted in his inability to ventilate himself resulting in death from mechanical asphyxia.

The second patient was a 92-year-old man who died as the result of bed entrapment and neck compression between a portable bed rail and the mattress of his bed. He was found with the lower part of his body on the floor, with his head trapped between rail and mattress.

This case involved entrapment in between the rail and mattress. If this distance is too large, head entrapment can occur. The recommended distance is less than 120mm.

Between 1985 and January 1, 2009, 803 incidents of patients caught, trapped, entangled, or strangled in beds with rails were reported to the U.S. Food and Drug Administration. Of these reports, 480 people died, 138 had a nonfatal injury, and 185 were not injured because staff intervened. Most patients were frail, elderly or confused.

Clear standards exist for both fixed bed rails and portable bed rails to minimize the risk of bed entrapment. Safety standards recommend that portable bed rails be securely anchored and that no gaps exist between the mattress and rail.

The FDA in the United States has defined adult portable bed rails as “any bed rail product or device that is attachable and removable from a bed, not designed as part of the bed by the manufacturer, and is installed on or used along the side of a bed.”

In October 2015, Health Canada re-announced a recall of several bed rails following the report of an entrapment death. This recall stated that, “when attached to an adult’s bed without the use of safety retention straps, the handle can shift out of place, creating a dangerous gap between the bed handle and the side of the mattress. This poses a serious risk of entrapment, strangulation and death.”

Although in this particular case, the patient’s bed rail might have been compliant with the standards, “bed rails should be used with care and only after a full, documented risk assessment has been carried out for each patient, stated the Committee.

The Geriatric and Long-Term Care Review Committee recommends that acute care and long-term care facilities, both licensed and unlicensed, have a detailed policy regarding the use of restraints (chemical and physical, including bed side rails). All staff caring for patients should review these policies (i.e. inservices) on a regular basis. New staff should be oriented to these policies prior to commencing patient contact. These policies should include detailed instruction on the various types of restraints, their application, and ways to maximize safety.