Any decision regarding bed rail use or removal should be made based on the individual patient or resident assessments. If a bed rail has been determined to be necessary, steps should be taken to reduce the known risks associated with its use. To learn more about the patient/resident assessment, see the Clinical Guidance for the Assessment and Implementation of Bed Rails in Hospitals, Long Term Care Facilities and Home Care Settings.

Before you install bed rails:

• Make sure the individual is an appropriate candidate for bed rails. Bed side rails should not be used as a substitute for proper monitoring, especially for people at high risk for entrapment.
• Use the recommendations in the FDA Guidance “Hospital Bed System Dimensional and Assessment Guidance to Reduce Entrapment” for health care facilities and manufacturers and the Clinical Guidance for the Assessment and Implementation of Bed Rails in Hospitals, Long Term Care Facilities and Home Care Settings. Currently there are no design standards for adult portable bed rails. Voluntary consensus standards are in development.
• Be aware that not all bed rails, mattresses, and bed frames are interchangeable and not all bed rails fit all beds. Check with the manufacturer(s) to make sure the bed rails, mattress, and bed frame are compatible, since most bed rails and mattresses are purchased separately from the bed frame.
• Rails should be selected and placed to discourage climbing over rails to get in and out of bed, which could lead to falling over bed rails.
• Avoid the routine use of adult bed rails without first conducting an individual patient or resident assessment.
• Restrict the use of physical restraints, including restrictive use of bed rails, or chest, abdominal, wrist, or ankle restraints of any kind on individuals in bed.

When installing and using bed rails:

• Select an appropriate bed rail for age, size and weight of the person using the bed rail.
• Be aware that not all bed side rails, mattresses, and bed frames are interchangeable and not all bed rails fit all beds. Check with the manufacturer(s) to make sure the bed side rails, mattress, and bed frame are compatible.
• Follow the health care facility's procedures and/or manufacturer’s recommendations/specifications for installing and maintaining bed rails for the particular bed frame and bedside rails used.
• Inspect and regularly check the mattress and bedrails to make sure they are still installed correctly and for areas of possible entrapment and falls. Regardless of mattress width, length, and/or depth, the bed frame, bed side rail, and mattress should leave no gap wide enough to entrap a patient's head or body.
• Regularly assess that bed rails remain appropriately matched to the equipment and to the patient’s needs, considering all relevant risk factors.
• Inspect, evaluate, maintain, and upgrade equipment (beds/mattresses/bed rails) to identify and remove potential fall and entrapment hazards.
• Re-assess the person’s needs and re-evaluate the equipment if an episode of entrapment or near-entrapment occurs, with or without serious injury. This should be done immediately because fatal “repeat” events can occur within minutes of the first episode.
• Be aware that gaps can be created by movement or compression of the mattress which may be caused by patient weight, patient movement or bed position, or by using a specialty mattress, such as an air mattress, mattress pad or water bed.
• When in doubt, call the manufacturer of the rails for assistance.