Ftag of the Week – F700 Bed Rails (Pt 1)

Up next in CMS Compliance Group’s “Ftag of the Week” Blog Series is F700 Bed Rails, which is part of the Quality of Care regulatory group. For the purposes of F700, the Centers for Medicare and Medicaid Services (CMS) provides the following examples of bed rails: side rails, bed side rails, safety rails, grab bars and assist bars. This is an important regulation to know the details of since the use or side/bed rails can increase the risk of injury to a resident. That’s why it is essential that nursing homes attempt alternatives prior to using bed rails, but if the IDCPT decides there is a need to use side rails to treat a medical symptom, the appropriate use, correct installation and routine maintenance are in completed.

CMSCG’s consultants routinely audit bed rail use at our client facilities, and our consultants’ common findings are ones that, if not addressed, could result in serious harm or even death to a resident. This is because even with appropriate bed rails that are compatible with the bed and mattress being used, and are appropriately used, there is still a potential increased hazard for certain individuals. The risk of entrapment also needs to be considered.

The Interpretive Guidance (IG) notes that individuals with physical limitations or altered mental status, including individuals living with dementia, are at a higher risk for a negative outcome when bed rails are in place. Residents who are at the highest risk for entrapment include frail or elderly individuals who have conditions that may result in them trying to move in the bed or try to exit the bed. The IG notes that residents with the following conditions could make them more likely to try to move around or exit the bed:

• Pain
• Uncontrollable body movement
• Agitation
• Delirium
• Confusion
• Acute urinary retention
• Fecal impaction
• Hypoxia

Think about what could happen to that resident who tries to re-position him or herself to relieve pain from not being turned and re-positioned timely or the resident who does not want to wait any longer for assistance to the bathroom and tries to exit the bed. There is a potential for negative outcomes – and a long, unfortunate history of facilities being cited when not appropriately using and maintaining bed rails – so it is important that the potential benefits of side rail use are considered alongside the potential risks to determine what is best for the resident.

Let’s look at what needs to be in place for resident safety.

F700 – Regulatory Requirements

If a facility plans to install a bed or side rail for a resident, appropriate alternatives must be attempted prior to using the side/bed rail. If the alternatives attempted do not meet the resident’s needs, then the facility may consider installing bed rails. Providers are responsible for assessing the resident’s risk of entrapment prior to installation and reviewing the risks and benefits of bed rails with the resident/ representative. Informed consent must be obtained prior to installation. Once the go-ahead has been given to install bed rails, the facility is required to follow manufacturer’s recommendations and specifications for installation and ensure that the dimensions of the resident’s bed are appropriate for both the resident’s size and weight. The nursing home is also required to ensure the correct use of the bed rails and follow manufacturer’s specifications for maintaining the bed rails.

What All Needs to be in Place for Compliance

This means that to be compliant with the requirements at F700, the facility must be able to:

• Demonstrate that it has identified and attempted the use of appropriate alternatives prior to installing a bed rail for a resident
• Show that the resident has been assessed for risk of entrapment prior to bed rail installation and use
• Have documentation available that the resident/ representative has been provided with education and information regarding the risks and benefits of bed rails and obtain informed consent

The facility is also responsible for ensuring that:

• The bed’s dimensions are appropriate for the resident’s size and weight
• The bed rails are correctly installed per manufacturer’s recommendations/ specifications
• The side/ bed rails that have been installed are correctly used
• Scheduled maintenance of a bed rail in use in the facility is completed per manufacturer’s recommendations/ specifications

A facility needs a solid assessment plan by the IDCPT for determining use of any bed rail device; even a simple device like a “U” grab bar has resulted in a resident sustaining a fracture – not when using the grab bar to assist with sitting up or exiting the bed but having their arm caught in it when repositioning themself. Let’s not forget those family requests that mom must be safe when in bed and needs her side rails – so a facility puts the rails on the bed and mom climbs out of bed around the rails and falls and fractures her hip. 

Why worry? Residents get injured when they grab the rail to turn over and the rail falls off and they fall from the bed and fracture their nose or how about a resident who is given a bed with a poorly fitted mattress and that small ¼ side rail traps their head between the mattress, side rail and bedframe and they asphyxiate. Side rail use is not a winner!

In Part 2 of CMSCG’s “Ftag of the Week” for F700 Bed Rails, we will dig into the details needed to be compliant with the above-mentioned requirements, including the resident assessment and education and informed consent. After that, we will look at the nitty-gritty of what to be aware of related to the installation of bed rails and maintenance and supervision.