Given that bed rails fall under the category of restraints, it is to be expected that all SNFs exercise due diligence after installation to avoid civil action and penalties from the government. After the installation of bed rails, a number of procedures must be followed. These include written reports in the resident’s record which list data such as the specific type of direct monitoring during the use of bed rails, identification of how needs will be met (for repositioning, hydration, meals, use of the bathroom, and hygiene), the measures being taken to ensure that the bed rail is effective in meeting the resident’s needs, and an ongoing evaluation of risks which they may pose. SNFs should also be aware that there are eight key elements of noncompliance, and that failure to adhere to any one of these can lead to CMS penalties. These eight key elements are:
1. The facility failed to identify and use appropriate alternatives prior to installing a bed rail.
2. The facility failed to assess the resident for risk of entrapment prior to installing a bed rail.
3. The facility failed to assess the risk versus benefits of using a bed rail and review them with the resident or, if applicable, the resident’s representative.
4. The facility failed to obtain informed consent for the installation and use of bed rails prior to the installation.
5. The facility failed to ensure appropriate dimensions of the bed, based on the resident’s size and weight.
6. The facility failed to ensure correct installation of bed rails, including adherence to manufacturer’s recommendations and/or specifications.
7. The facility failed to ensure correct use of an installed bed or side rail.
8. The facility failed to ensure scheduled maintenance of any bed rail in use according to manufacturer’s recommendations and specifications.
CMS has four severity levels by which they measure the extent of the penalty. Severity Level 4, “Immediate Jeopardy to Resident Health or Safety” will include infringements such as the failure to use alternatives or to properly assess the risks of entrapment. Severity Level 3, “Actual Harm that is Not Immediate Jeopardy,” relates to infringements which can cause discomfort, such as the failure to ensure that bed dimensions are appropriate for the resident.
Severity Level 2, “No Actual Harm with Potential for More Than Minimal Harm that is Not Immediate Jeopardy,” includes events such as the failure to properly inform a resident or his/her representative about the risks and benefits of using side rails. Severity Level 1, “No Actual Harm with Potential for Minimal Harm” includes infringements such as the failure to have a schedule for routine maintenance of beds with bed rails. Avoiding all of these pitfalls is a matter of correct staff training, preparation, and coherent record-keeping—a commitment which any professional SNF is legally and morally obligated to make.
