Policy: Compassionate Care Team Ltd understands that bed rails are not recommended except in specific circumstances and only after a full assessment of the risks has been made. Wherever possible, an alternative method will first be explored to reduce the risk of harm to a Service User falling from the bed. When the use of bed rails is being considered, a full risk assessment, including the risks and benefits, will be undertaken. This will assist with the professional decision-making process and provide a record for reassessment and audit purposes. A bed rail will never be used in an effort to restrain a Service User or limit their level of freedom from leaving their bed as this can lead to unsafe and unethical practices. Bed rails at Compassionate Care Team Ltd will only be used at Compassionate Care Team Ltd if the following can be satisfied: • They are only provided when they are the right solution to prevent falls • A risk assessment is carried out by a competent person, taking into account the bed occupant, the bed, the mattresses, bed rails and all associated equipment • The rail is suitable for the bed and mattress • The mattress fits snugly between the rails • The rail is correctly fitted, secure and subject to rigid inspection and maintenance checks • Gaps that could cause entrapment of the neck, head and chest are eliminated • Staff are trained in the risks and safe use of bed rails Staff who support Service Users with bed rails are responsible for: • Maintaining and adhering to the standards set in this policy and accepting accountability for their own practice • Attending training and maintaining knowledge of the safe use of bed rails • Reporting all incidents and near misses involving the use of bed rails • Undertaking/cooperating with audit • The completion of accurate and contemporaneous documentation
All efforts will be made to ensure that the Service User is given the opportunity to be involved in the decision making process as to whether bed rails are used. If the Service User lacks capacity, Compassionate Care Team Ltd has a duty of care to decide if bed rails are in the Service User’s best interests and this must be documented in the Service User's Care Plan in line with the Mental Capacity Act. Consideration should be given as to whether the use of bed rails will constitute a Deprivation of Liberty
Procedure Assessments • Bed rails will not be used until a full assessment has taken place. This includes the completion of a risk assessment • Staff must be competent and trained when supporting Service Users who need bed rails • The Bed Rail Risk Assessment Flowchart should be used to aid decision making
Alternatives to Bed Rails Alternatives to bed rails may be the most appropriate method of managing a Service User's risk of falling, slipping or sliding out of bed.
Alternatives to bed rails include: • Moving Service Users to a more observable area to aid supervision • Using a bed sensor and/or position device • Using a high/low bed • Using soft cushioning on the floor to break a Service User's fall, such as a crash mat. However, crash mats may introduce Service User handling risks • Ensuring the bed is returned to the lowest height after care has been delivered • Ensuring Service Users' needs are anticipated, i.e. accessible drinks, regular toileting, call bell to hand • Increased monitoring of Service Users at high risk of falling • Using mesh, netting or inflatable sides • Reducing and eliminating sedation • Supporting the Service User on a mattress on the floor. This should be a last resort and safety checks would be required to ensure risks are minimised. A Moving and Handling Risk Assessment for staff must be completed This list is not exhaustive. It is recognised that some of the safety options outlined above may not be acceptable to Service Users or their families. The Service User's safety must be balanced against the wishes and/or best interests of the Service User. The Service User, (or in the absence of proven capacity, their family/representatives) need to be included in discussions to establish an acceptable level of risk. Any suchdiscussions must be documented and kept with the Service User's care records.
Consent Consent should always be sought in the first instance from the Service User. If the Service User is shown not to have capacity, then a Best Interests Meeting must take place including the Service User's next of kin. If it has not been possible to gain consent, this should be documented on the pre-assessment and sought at the earliest opportunity. Where it has been identified that the Service User may not have the capacity to consent, an assessment under the Mental Capacity Act must be undertaken. When concerns arise that may result in bed rails being required, Compassionate Care Team Ltd should assist, where required, with the assessment for the need for bed rails. Where bed rails are required, staff will complete the risk assessment and care planning documentation. Bed rails must not be used if: • The Service User is agile enough or confused enough to climb over them • The Service User would be independent if the bed rails were not in place When a Service User chooses to have bed rails without having a determined risk, staff should ensure that the appropriate strategies are in place to allow the Service User to get out of bed when necessary and that the decision is recorded clearly. In accordance with the Service User Care Planning Policy and Procedure at Compassionate Care Team Ltd, risk assessments and Care Plans will be reviewed frequently, if the Service User's condition changes or if there is a replacement of any part of the bed or bed rails. Beds must usually be kept at the lowest possible height to reduce the likelihood of injury in the event of a fall, whether or not bed rails are used. The exception to this is independently mobile Service Users who are likely to be safest if the bed is set at the correct height for them to sit on the side of the bed. Bed rails must not be used for moving and handling purposes unless they are integrated bed rails which are deemed by the manufacturer to be suitable for this purpose. In this case, a Moving and Handling Risk Assessment must be completed. When staff are attending to the Service User to deliver personal care, the bed should be positioned at a height that meets the moving and handling preferences of the Care Workers attending. Bed rails should be in the down position during personal care delivery until staff are ready to move away from the bed. Bed rails must be locked into the upright position if staff move away from the bed at any time.
Medical Device Requirements Bed rails are medical devices and therefore all responsibilities in relation to safe practice will need to be adhered to. Staff should refer to the Management of Medical Devices Policy and Procedure for further information. However, as a minimum the following must be adhered to: • Staff should only be using this equipment if trained and deemed competent to do so • Equipment must be well maintained, serviced, clean and fit for purpose • Manufacturers' guidance should be accessible • All staff have a responsibility to report any defects immediately and condemn the item until it is proven safe for use • Any accidents or incidents in relation to bed rails must be reported to the senior staff member on duty and an accident/incident record completed
Bed Rail Protectors Bed rail protectors are used to prevent impact injuries, but they can also reduce the potential for limb entrapment when securely affixed to the bed or rail, according to the instructions for use. However, bumpers that can move or compress may themselves introduce entrapment risks. For Service Users who are assessed as requiring bed rails but who are at risk of striking their limbs on the bed rails, or getting their legs or arms trapped between bed rails, bed rail bumpers must be used. Where a Service User declines the use of bed rail protectors, this decision will be respected and documented with other strategies discussed and implemented. Staff have a duty, where these are used, to ensure that they are clean and well maintained. The risk assessment must include the rationale for the use or exclusion of bed rail protectors. Before each use, staff should check the protector for any rips, tears or deficits. Where these are found, Compassionate Care Team Ltd should be notified immediately so that the defects can be reported and action taken to remove, replace or repair the faulty equipment.
Fitting of Bed Rails Where possible, when bed rails are in use, these should be integrated rails and the practice of using bed rails that are required to be manually fitted to bed frames should be avoided. To reduce the risk of entrapment, staff must ensure that, when using detachable bed rails, they comply fully with the measurements as per the MHRA's 'Safe use of bed rails' document: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/422784/Safe_use_of_bed_rails.pdf
Maintenance of Bed Rails Care Workers are responsible for ensuring that bed rails are checked at every care intervention. A visual check must be completed to ensure that they remain safe, fit for purpose, are clean and well maintained. Visual checks must be documented to evidence that checks have been made.
Maintenance Staff Safety Checks All bed rails or beds with integral rails must have an Asset Identification Number and be regularly maintained and serviced. Bed rails must be maintained in accordance with the manufacturer’s recommendations in the instructions for use. Maintenance checks should be recorded and retained. Outcomes of the maintenance checklist should be discussed with Miss Naomi Bennett.
Infection Control Bed rails and bed rail protectors should be included in cleaning schedules and cleaned in accordance with manufacturers' guidelines. Review The continued use of bed rails must be reviewed by staff each time there is a change in circumstances involving the Service User. Miss Naomi Bennett will have an oversight of the culture of the use of bed rails within Compassionate Care Team Ltd and support staff with considering the right approach to managing the safety of Service Users. Accident and incident records will be used to review practice, monitor compliance with this policy and ensure that there is a timely review of strategies in place for the Service Users involved.
Training and Education Staff responsible for the care and support of Service Users will be trained to use bed rails safely before any use. This will form part of the induction programme offered within Compassionate Care Team Ltd and competence will need to be proven. Ongoing, staff will be expected to maintain their knowledge and competence of the safe use of bed rails via this policy and associated resources. Accidents and incidents relating to bed rail use will be used to reflect on practice and provide a learning opportunity and culture for safer practice.