Nursing Home Neglect: The Danger Of Side Rail Entrapment

Bed rails, if not properly managed, can cause serious injuries and death.  The hazard exists when there is a gap between the mattress  and the bottom of the rails allowing entrapment of the head and body parts.  OBRA 483.25(h) imposes strict obligations on the facility to ensure that (1) the resident environment remains as free of accident hazards as is possible; and (2) each resident received adequate supervision and assistance devices to prevent accidents.
The FDA recommends a dimensional limit of less than 4.75 inches for the area between the rails and also between the rail and the mattress.  In Meadowwood Nursing Center v. Centers for Medicare and Medicaid Services, DAB No. C-12-18 (decided June 17, 2013), the Honorable Joseph Grow, Administrative Law Judge, Department of Health and Human Services, addressed the case of a 74 year old woman with multiple conditions including a stroke with left-sided paralysis, aphasia, anxiety disorder, depression and schizophrenia.  The resident was found with her head under the side rail.  The side rail was causing substantial pressure on the resident’s neck. The rail weighed approximately 6 pounds.
The Guidance for Industry and FDA Staff  Hospital Bed System Dimensional and Assessment Guidance to Reduce Entrapment (2006 FDA guidance) which describes “entrapment” as “an event in which a patient/resident is caught, trapped or entangled in the space in or about the bed rail, mattress, or hospital bed frame”.  The FDA found that “[t]he population most vulnerable to entrapment are the elderly patients and residents, especially those who are frail, confused, restless, or who have uncontrolled body movement.”
The Court was presented with evidence from the bed’s manufacturer which warned that if the head of the bed was raised 30 to 45 degrees, there could be a gap that posed an entrapment risk unless the bed rails were in a “MID” position to allow the rails to remain below the top of the mattress.  Bed rails have 3 positions, upper, lower and middle.
The Court found that the facility was not taking all reasonable steps to prevent the foreseeable risk of resident entrapments in the side rails of beds and upheld the fine imposed by the Center for Medicare and Medicaid Services.