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f all the issues facing the long-term care industry today, perhaps none are more prominent than the two issues of resident falls and bed siderails (restraints). Across the country, care providers are facing the reality of reducing and eliminating patient restraints, including siderails. At the same time, resident falls have also come to the forefront as an extremely important issue; it's now nearly impossible to find a facility without a special falls committee focused on reducing the injuries sustained to residents, often caused when they are transferred or climb out of bed.
       The attention that these two issues are receiving is for good reason. Consider the following statistics:
- In the United States, one of every three people 65 years old and older falls each year.
- By 2020, the cost for fall injuries is expected to reach a total of $32.4 billion.
- Between 1985 and 1999, 371 incidents of patients caught, trapped, entangled, or strangled in beds with rails were reported to the FDA. Of these reports, 228 people died, 87 had nonfatal injuries, and 56 were not injured because staff intervened.
       Patients that have difficulty sleeping, memory problems, pain, uncontrolled body movement, or those who get out of bed without assistance are highly susceptible to entrapment and fall hazards. These are exactly the individuals that the siderail is supposed to protect.
       The costly nature of these incidents--falls and entrapments--from the standpoint of injuries, increased medical expenses, and also litigation have left many administrators and nursing executives looking for answers. In truth, there is no simple answer. However, there is a two-pronged approach to handling these issues that are not unrelated.
       The first step in solving this problem is to develop a fall prevention program. The preliminary stage in this program should be to train all staff in the assessment and monitoring of potential and ongoing fall risks. However, perhaps the single most effective method to reduce fall injuries is the implementation of electric low beds.
       Low beds are generally acknowledged as beds that sit less than eight inches from the floor and raise to a comfortable working height for staff. The varied height range allows residents to rest comfortably at the lowest height level, virtually eliminating the risk of serious injury caused by falls at higher heights. In addition, the functionality of the low bed, when raised to higher elevations, allows nursing and housekeeping staff greater ease and less strain in performing their jobs.
       Current statistics indicate that 54 percent of falls are over bedside rails. In addition to implementing low beds, bed siderails designed to ease and assist residents in entering and exiting the bed help to minimize fall risks. These siderails provide residents with the freedom to rest in an unencumbered environment while allowing staff easy access to patients. As well, bed rails that do not span the length of the bed help to dissuade residents from climbing over rails.
       The second step in developing a safer room environment is to address the hazards posed by bed siderails. The easiest way to measure the safety of your bed rails is to review the new FDA guidelines for entrapment. These guidelines were formulated over the last three years by the Hospital Bed Safety Workgroup (HBSW), a coalition of healthcare professionals, manufacturers, patient advocacy groups, and various governmental parties headed by the FDA.
       To properly assess whether or not your beds meet the guidelines set out by the HBSW, seven entrapment zones were established, to which your bed and siderails can be measured.
       The statistics discussed within this article, although discouraging, lead many healthcare providers to question, "What is the best way to limit entrapment and fall risks?" Unfortunately, the answer is not simple.
       Perhaps the single most important thing a facility can do in response to entrapment and fall issues is to investigate new bed designs. Understandably, not every facility will be immediately prepared or able to replace all existing beds with new low beds and fully compliant rails. Some facilities may believe the risks associated with falls and entrapment far outweigh the costs of purchasing new beds. While others, who may have recently purchased beds, may need to look to short-term solutions. The important element is to have a plan. Take an inventory of your current beds, determine which will require the most urgent replacement, and then set a schedule.