Safety Facts About: Bed Rails In Hospitals, Nursing Homes and Home Health Care

Bed Rail Entrapment Statistics

Safety is important. Today there are about 2.5 million hospital and nursing home beds in use in the United States. Between 1985 and 2009, 803 patients* were injured in beds with railings were reported to the U.S. Food and Drug Administration. Of these, 480 people died, 138 had a nonfatal injury, and 185 were not injured because staff intervened. Most patients were frail, elderly or confused.

Patient Safety

It is important to assess patients who have problems with memory, sleeping, incontinence, pain, uncontrolled body movement, or who walk unsafely without help. This is to provide the best way to keep them from harm, such as falling. Assessment by the patient’s health care team will help to determine how best to keep the patient safe. Historically, physical restraints (such as ankle or wrist restraints) were used to keep patients safe in health care facilities. Now, the health care community recognizes that physically restraining patients can be dangerous. Although not indicated for this use, bed rails are sometimes used as restraints. Many groups now encourage hospitals, nursing homes, etc. to assess patients’ needs. It is important to provide safe care without restraints.

The Benefits and Risks of Bed Rails

Potential benefits of bed rails include:
• Aiding in turning and repositioning within the bed.
• Providing a hand-hold for getting into or ou tof bed.
• Providing a feeling of comfort and security.
• Reducing the risk of patients falling out of bed when transported.
• Providing easy access to bed controls and personal care items.

Potential risks of bed rails may include:
Injury or death (strangling, suffocating, etc.) when body parts get caught between rails or between the rails and mattress.
• More serious injuries from falls when patients climb over rails.
• Skin bruising, cuts, and scrapes.
• Inducing agitated behavior when bed rails become aids in restraining the patient.
• Feeling isolated or unnecessarily restricted.
• Preventing patients from performing routine activities such as going to the bathroom.

Meeting Patients’ Needs for Safety

Most patients can be in bed safely without bed rails. Consider the following:
• Use beds that raise and lower to the floor to accommodate both patient and health care worker needs.
• Keep the bed in the lowest position with wheels locked.
• Place mats next to the bed, as long as this does not create a greater risk of accident, to prevent falling.
• Use transfer or mobility aids.
• Check patients often.
•  Expect the reasons patients get out of bed. These include hunger, bathroom needs, that can be met providing aid before needs arise. When using bed rails, perform on going assessments of the patient’s. Check high-risk patients.

Consider the following:
• Lower one or more sections of the bed rail, such as the foot rail.
Use the right mattress size or raised foam edges to prevent patients from entrapment between the mattress and rail.
• Reduce the gaps between the mattress and side rails.

Which Ways of Reducing Risks are Best?

Ongoing patient evaluation and monitoring will result in optimizing bed safety. Many patients go through a period of change to become comfortable with new options. Patients and their families should talk to their health care team to find out options best for them.

Patient or Family Concerns About Bed Rail Use

If patients or family ask about using bed rails, health care providers should:
Encourage patients/family to talk to their health care team to determine what is needed.
Reassure patients and families that the patient can sleep safely without bed rails.
• Reassess the need for using bed rails on a frequent, regular basis.

Developed by the Hospital Bed Safety Workgroup

Participating Organizations:
• ABATort and Insurance Practice Section
American Association of Homes and Services for the Aging
American Health Care Association
American Medical Directors Association
American Nurses Association
• American Society for Healthcare Engineering of the American Hospital Association
American Society for Healthcare Risk Management
• Basic American Metal Products
• Beverly Enterprises, Inc.
• Care Providers of Minnesota
• Carroll Healthcare
DePaul College of Law
• Evangelical Lutheran Good Samaritan Society
Hill-Rom Co., Inc.
Joint Commission on Accreditation of Healthcare Organizations
• Medical Devices Bureau, Health Canada
National Association for Home Care
National Citizens’ Coalition for Nursing Home Reform
National Patient Safety Foundation
RN+ Systems
Stryker Medical
• Sunrise Medical, Inc.
• The Jewish Home and Hospital
• Untie the Elderly, The Kendal Corporation
U.S. Food and Drug Administration


To report an adverse event or medical device problem, call FDA’s MedWatch Reporting Program at 1-800-FDA-1088.
For more copies of this brochure, see the FDA’s website.
For more information about this brochure, contact Beryl Goldman via phone at 610-388-5580. Or email Beryl at
She has volunteered to answer questions.
For information about a specific hospital bed, contact the bed manufacturer.


October 2000 (Revised 4/2010)