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ed entrapment is a critical issue facing long-term care. Entrapment incidents can be devastating for resident safety and a facility’s reputation. Recently released Food and Drug Administration (FDA) entrapment guidelines state that an estimated 60% of the nearly 700 entrapment cases reported over the past 20 years have been fatal,1 and it is becoming increasingly clear that entrapment poses significant safety concerns to at-risk residents. With the release of these new guidelines, many facilities are preparing for strict state assessments and increased potential for liability citations, making it essential to understand the risks and how to resolve them.
       Direct Supply Equipment, a long-term care supplier of equipment (including bed systems), has worked with FDA officials to better understand how these new guidelines affect nursing homes and how facility staff can better protect at-risk residents from the dangers of entrapment. Because these new guidelines are detailed and can be confusing, it is important for the long-term care community to understand how the guidelines affect resident care as well as what staff can do to ensure that bed systems are as safe as possible. Considering the significance of the guidelines and the increased risk of liability, it is important for staff members to familiarize themselves with ways to protect their residents and facilities from bed entrapment.

What is Entrapment?

       Entrapment can occur when a resident experiences acute urinary retention, delirium, confusion, pain, or agitation. When these residents—especially those who are confused or restless or do not have full control over bodily movements—attempt to move within or exit their bed without assistance, they can become caught, trapped, or entangled in the space in or around the bed rail, mattress, or bed frame.
       Entrapment is certainly a serious threat facing long-term care today. In fact, it is probable that the number of entrapment incidents is even higher than the FDA’s estimation, as entrapment cases often go unreported. But as the long-term care industry gains more insight as to how and why entrapment occurs, it will be better able to work with long-term care professionals to detect and rectify the risks.

More about FDA Guidelines

       The new guidelines help to identify and reduce the risk of bed entrapment in a facility and provide safe bed systems for at-risk residents. They identify seven bed zones of potential entrapment risk and appropriate dimensions for each:
       Zone 1: Within bed rails
       Zone 2: Under the rail, between the rail supports, or next to a single rail support
       Zone 3: Between the rail and the mattress
       Zone 4: Under the rail, at the end of the rail
       Zone 5: Between split bed rails
       Zone 6: Between the end of the rail and the side edge of the head or footboard
       Zone 7: Between the head or footboard and the end of the mattress.
       Currently, the FDA only provides dimensional recommendations for zones 1–4, as an estimated 80% of entrapment cases have occurred in those zones. (To learn more about entrapment zones and/or the FDA guidelines, contact Direct Supply Equipment at 800-634-7328 for a free copy of its “Beds & Entrapment Guide.”) These guidelines have also made it more likely that those inspecting entrapment cases are equipped with the appropriate tools to accurately assess the root of incidence and determine liability for any injury or fatality.
       The FDA guidelines specifically address a new measurement tool to aid those who inspect entrapment incidents. The tool assesses bed entrapment zones and determines whether a facility’s beds meet dimensional safety criteria. Considering this increased risk of liability, it is vital to initiate actions to protect residents and facilities. (For more information about this tool, visit www.DirectSupply.net.)

Clinical Guidelines

       Because of the dangerous risk bed rails play in many entrapment cases, the Hospital Bed Safety Workgroup (HBSW) issued “Clinical Guidance for the Assessment and Implementation of Bed Rails in Hospitals, Long-Term Care Facilities, and Home Care Settings” in conjunction with the FDA guidelines. The comprehensive guide helps caregivers to assess and determine a resident’s need for bed rails and additional assistive devices.
       Using bed rails for residents at risk of entrapment may create serious safety hazards. Though bed rails can serve a variety of resident health and safety purposes, it is essential for staff to weigh the risk of entrapment versus the clinical benefit of using rails.
       This can be done by forming committees to perform the assessments outlined in the FDA criteria to identify at-risk residents. Based on its committee’s findings, a facility can then determine combinations of beds and accessories that will best protect its residents from entrapment.

Mitigation Guidelines

       To protect residents from the dangers of entrapment, a facility need not always replace its beds. Mitigation guidelines have been developed to help facilities reduce the risk of entrapment in their existing hospital bed systems. Intended for use along with clinical resident assessments, these guidelines focus on modifying a facility’s current beds to make them safer for residents and include seven steps to ensure they are safe:
1. Assign responsibility. Assemble a small, interdisciplinary group of staff members responsible for reducing entrapment risks and determining effective solutions.
2. Determine high-risk clinical units (if appropriate). High-risk units are those with residents of higher acuity levels, lower visibility of residents, and resident monitoring challenges due to staffing shortages.
3. Take inventory of bed systems. An inventory helps to identify the need for replacements and new assistive devices.
4. Evaluate bed systems for conformance to the FDA’s bed system entrapment dimensional guidelines. Both a summary and the full FDA guidelines are included in Direct Supply Equipment’s “Beds & Entrapment Guide.”
5. Initiate corrective actions. After assessing at-risk residents and considering dimensional recommendations, select the appropriate beds and accessories to eliminate potential entrapment zones.
6. Seek guidance for purchasing beds. By effectively implementing steps 1–5, your staff will be able to identify which types of beds, accessories, and mattresses will provide the safest protection against entrapment.
7. Implement quality monitoring. Once corrective actions have been taken, it will be necessary for your staff to closely monitor your residents to ensure they stay protected.
       Often, a facility can modify residents’ beds by simply replacing bed rails with other bed accessories. Determining their use in your facility will depend on the results of thorough resident assessments. Common accessories that can be used for the appropriate residents include bedside mats, adjustable-height low beds, resident alarms, and mattresses with raised side bolsters.

Conclusion

       A facility need not navigate the new bed entrapment guidelines alone. Direct Supply Equipment has worked closely with the FDA to better understand these new guidelines and is prepared to help facilities find ways to implement them based on their unique needs. Long-term care professionals can rely on the company for assistance with understanding entrapment and upgrading or replacing their current bed systems to better protect residents. Its eldercare experts can also provide valuable product selections and regulatory information to help facilities protect vulnerable residents and adhere to the new entrapment guidelines.