The overuse of bed rails, particularly in environments with vulnerable populations, have created incidents where resident safety has been compromised.  The use of rails must be appropriate to the bed used and meet safety standards to prevent entrapment.  Entrapment occurs when a person is entangled or trapped within a space in or around a bed rail.  Resident injury or even death has occurred as a result of entrapment with bed rails.  Standard or automatic use of bed rails without individualization to the resident can affect resident autonomy.  Bed rails may also become a form of restraint when improperly used. 

There are appropriate reasons for the use of bed rails for safety and mobility.  Prior to use, assessment and alternative measures must be utilized.  Additionally, the informed consent of the resident or representative is required before use.  The beds and rails must be evaluated by the facility management department.  Provider orders must also reflect the individualized need for bed rails.  Ongoing assessments of the continued need, in addition to monitoring of the equipment are also required.

Regulations regarding the safe use of bedrails in long-term care have changed over the years, with an increased focus on appropriate use for resident safety.  The Centers for Medicare & Medicaid Services (CMS) have structured requirements for bedrails within the State Operations Manual, appendix PP.  For long-term care facilities, failure to meet these regulations can cause financial penalties and will affect accreditation.  Continued non-compliance will result in enforcement actions up to and including termination from participating in Medicaid and/or Medicare services