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Bed entrapment: killed by the side rails

Bed entrapment: killed by the side rails

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Pressure relief mattresses

mattress entrapment, Dr. Diane Krasner, bed rails, side rails, pressure sores
Pressure relief mattresses treat the risk of pressure sores, but also create another risk: death. Selecting the correct mattress for pressure relief should take into account these factors in MATTRESS:

Microclimate and moisture
Activity levels
Tissue tolerance
Total body weight
Repositioning needs
Shear and friction
Symptom management

Bed entrapment

When considering support surfaces in bed, healthcare providers must consider the risk of entrapment. Health Canada and the FDA have released documents defining the seven zones of entrapment and guidance measurements:

1. Within the bed rail
2. Under the rail
3. Between the rail and the mattress
4. Under the rail at rail ends
5. Between split bed rails
6. Between end of rail and side edge of head or foot board
7. Between head or footboard and mattress end.

Prescription of a therapeutic support surface, whether an overlay or mattress replacement, may impact several of these zones (e.g. zone 2, 3, and 7). A standard measuring device is available to check to see if the new support surface increases the risk of entrapment by allowing spaces greater than those outlined in the guideline. The risk of entrapment may also be greater with support surfaces with large air bladders (these are usually found on low air loss, alternating, or rotating surfaces). These surfaces tend to collapse the further the individual moves to the edge of the surface, even when a perimeter border is present within the mattress.

Entrapment risk: Liability

When an entrapment risk has been identified, bed rails should only be used with extreme caution, and be based on the needs of the individual patient. Some patients find the half bed rail at the head section helpful for repositioning. Another approach for people at high risk is to use an adjustable bed with a very low deck height and a floor mat. This approach allows the bed to be raised during care, to a comfortable height for care providers but allows the bed to be low enough to help prevent injury if the person falls out of bed. Foam wedges and other devices are also available to help reduce the risk of entrapment.

The standard of care will focus on the correct selection of the mattress based on the identification of risk, and monitoring the patient.

bed rails, pressure sores, mattress entrapment, side rails

Dr. Diane Krasner

Modified with permission

from Kestral Woundsource Devices White Paper, coauthored by Dr. Diane Krasner, November 2011

Get in on the shifting thinking about pressure sores by learning from one of the experts in the field. Dr. Krasner explores these and other controversies in an all new multimedia course that took place on February 27 and March 5, 2012. Get the on-demand recordings for Pressure Sore Case Analysis and Reports here.

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