Other risk factors (such as inappropriate use or incompatibility) are included in the MHRA’s updated guidance on the management and safe use of bed rails and should be considered as part of an appropriate risk assessment. An example risk assessment is provided in Appendix 1 of the guidance. Assessment of appropriate bed rails should be routinely incorporated in the clinical assessment of all patients. Investigations into incidents involving falls often found the likely cause to be worn or broken parts, which should have been replaced during regular maintenance and servicing, but which were either not carried out or were carried out improperly.

Have you made sure that there no gaps present that could present an entrapment risk to any part of patient’s body? Action 5. Organisations which regularly require beds for children and for children and adults with atypical anatomy should plan to replace non-compliant beds as soon as possible. This was a breach of Regulation 12(1) and 12(2) as care and treatment were not provided in a safe way. The service was rated as inadequate against the question, ‘Is the service safe?’. Review the medical device management system (inventory/database) for your organisation or third-party provider for devices within your organisation, including those which have been provided to a community setting (for example, the patient’s own home). Keep this system up to date. National Patient Safety Alert: Medical beds, trolleys, bed rails, bed grab handles and lateral turning devices: risk of death from entrapment or falls (NatPSA/2023/010/MHRA) - GOV.UKAccording to investigations, deaths were found to involve factors including inadequate risk assessment, maintenance issues and children and adults of small stature using beds which are designed for use by adults with typical body dimensions.

Review patients who are children or adults with atypical anatomy as a priority. Ensure the equipment they have been provided with is compliant with BS EN 50637:2017 unless there is a reason for using a non-compliant bed. Record this on the risk assessment and put in place measures to reduce entrapment risks as far as possible. a risk assessment is carried out by a competent person taking into account the bed occupant, the bed, mattresses, bed rails and all associated equipmentDo you have enough information from the supplier to be able to select and fit the bed rail appropriately? Suitable for all divan beds, slatted beds and profiling divan beds. Not suitable for electrically height adjustable beds trapping between the bedrail and mattress, headboard or other parts because of poor bedrail positioning.