Long-Term Care Survey Alert

How do surveyors view bed side rails?

As immediate jeopardy if a resident suffers a serious injury or death as the result of their use.

"As a practical matter, surveyors almost always treat such a situations as IJ," says attorney Carol Rolf with Rolf & Goffman in Cleveland. "They'll say the facility obviously didn't supervise the resident well enough to prevent the accident or pad the side rails" or whatever, she warns.

"That's because side bed rails are a known hazard in the industry and there are many established practices facilities can employ to mitigate that risk up front," Rolf notes. (See the latest Joint Commission guidance on this issue in the next article - #7.)

Even if a resident has a less serious bed rail injury, surveyors may still cite IJ especially if they tie the injury to a previous incident where the staff took no corrective action, says Deborah Ohl, principal of Ohl & Associates in Cincinnati. "Surveyors may tag the facility under assessment and care planning for failing to assess or modify the care plan when the previous injury occurred," she says.

Facilities can also get cited for inappropriate use of bed rails as restraints. Bed rails become restraints when they keep a resident from voluntarily getting out of bed, according to the Centers for Medicare & Medicaid Services.

When bed rails qualify as restraints, survey guidelines advise facilities to use them only to treat a resident's "medical symptoms" and never for staff convenience or at a family's request. Residents have the right to refuse side rails, CMS says. In addition, there's a long list of other assessment and care planning requirements the facility must meet when using bed rails as restraints.

CMS further notes that residents who attempt to exit a bed through, between, over or around side rails are at risk of injury or death. If staff observe a resident making any such maneuvers, it's time to move to safety plan B immediately.

"To fail to alter your plan of care in these circumstances is putting the resident in immediate jeopardy," emphasizes Joanne Rader. An associate professor at the Oregon Health and Science University in Portland, Rader is known for her research on restraint use and fall prevention in nursing homes.

Even surveyors agree that bed rails do have their place in long-term care facilities, but only when based on an individualized assessment showing that the benefits appear to outweigh the risks for a particular resident.

Rader agrees that in some cases bed side rails may help residents improve bed mobility and prevent them from rolling out of bed.

"Bed rails may also help the visually compromised resident feel more comfortable and secure in bed, as they provide a boundary," Ohl adds.