Bed entrapment may be fatal. What factors can lead to a patient being killed by a mattress?
I worked on a case involving a man who strangely himself on a side rail. The staff left the facility for a fire drill. The man, who had bilateral wrist restraints, slid off the mattress and got his chin stuck between the mattress and side rail.
When considering support surfaces in bed, healthcare providers must consider the risk of entrapment. Health Canada and the FDA have released documents defining the seven zones of entrapment and guidance measurements:
1. Within the bed rail
2. Under the rail
3. Between the rail and the mattress
4. Under the rail at rail ends
5. Between split bed rails
6. Between end of rail and side edge of head or foot board
7. Between head or foot board and mattress end.
Prescription of a therapeutic support surface, whether an overlay or mattress replacement, may impact several of these zones (e.g. zone 2, 3, and 7). A standard measuring device is available to check to see if the new support surface increases the risk of entrapment by allowing spaces greater than those outlined in the guideline.
The risk of bed entrapment may also be greater with support surfaces with large air bladders (these are usually found on low air loss, alternating, or rotating surfaces). These surfaces tend to collapse the further the individual moves to the edge of the surface, even when a perimeter border is present within the mattress.
Bed Entrapment risk: Liability
When a bed entrapment risk has been identified, bed rails should only be used with extreme caution, and be based on the needs of the individual patient. Some patients find the half bed rail at the head section helpful for repositioning.
Another approach for people at high risk is to use an adjustable bed with a very low deck height and a floor mat. This approach allows the bed to be raised during care to a comfortable height for care providers, but allows the bed to be low enough to help prevent injury if the person falls out of bed. Foam wedges and other devices are also available to help reduce the risk of entrapment.
The standard of care will focus on correct selection of the mattress based on identification of risk, and monitoring the patient.
Modified with permission from Kestral Woundsource Devices White Paper, coauthored by Dr. Diane Krasner
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