This week’s Ftag of the Week on the CMSCG Blog is F909 Resident Bed, which is part of the Physical Environment regulatory group. The regulation at F909 requires nursing facilities to conduct regular inspections of all bed frames, bed rails and mattresses as part of their routine maintenance programs to identify possible areas of entrapment. It further notes that when bed rails and mattresses are used but were not purchased with the bedframe, facilities are responsible for ensuring that all of the pieces are compatible.
Surveyors are instructed to see if equipment is inspected and maintained according to manufacturer’s recommendations, requirements and timeframes, if the mattress fits the bed frame properly, and if the facility assures that routine maintenance is being completed. It also directs surveyors to check if bed rails are securely and properly installed according to the manufacturer’s requirements so entrapment zones are limited.
F909 Resident Bed is one of the more frequently cited Ftags in this group – let’s look at why. F909 provides guidance regarding the inspection of and maintenance issues related to bed frames, mattresses and bedrails, but much of what has been cited on survey is solely related to bedrails. Bedrails can be a safety hazard, which is why the topic appears in the Requirements of Participation (RoPs) several times, including at F689 Free of Accident Hazards/Supervision/Devices as well as the stand-alone Ftag F700 Bedrails in addition to F909. Some examples of how this has been cited include:
- At an Immediate Jeopardy level after a power failure allowed a resident’s air mattress to deflate, allowing him to become trapped between the side rail and the mattress.
- Multiple times at a Widespread Scope/Severity (F) after facilities failed to ensure residents with bedrails had been assessed for risk of entrapment, including failure to take or document any measurements of the openings in the rail.
Conducting routine maintenance on beds is essential to ensuring resident safety. With mattresses being changed to meet resident needs and the type of bed rails being changed for a variety of reasons, it can be easy to overlook routine maintenance checks to make sure everything is compatible and in good working order. The FDA has issued multiple Guidance documents related to this topic, which can be viewed on the FDA website:
- 2006 FDA Guidance: “Hospital Bed System Dimensional and Assessment Guidance to Reduce Entrapment”
- 2013 FDA document “Practice Hospital Bed Safety”
- 2017 FDA Guidance: “A Guide to Bed Safety Rails in Hospitals, Nursing Homes and Home Health Care: The Facts”
If bed inspections are not part of your facility’s Preventative Maintenance Program, you should review your PMP and add bed inspections to it. A death related to a resident turning over in bed and being trapped between the bed rail and mattress and suffocating because they could not move him/herself from this position or a fracture related to someone becoming entrapped in a side rail opening are examples of what can occur if bed inspections are not routinely being done.