Bed Rails in Hospitals and Long-Term Care – Health Canada Safety Facts

Purpose of the Guidance

Health Canada issued this fact sheet to raise awareness of bed rail hazards in hospitals, nursing homes, and long-term care facilities. Bed rails, often used with the intent to prevent falls, can instead create serious entrapment and injury risks, particularly for frail, elderly, or confused patients. The document provides evidence-based recommendations to balance fall prevention with entrapment prevention. Bed Rails in Hospitals and Nursing Homes – Fact Sheet - Canada.ca

Key Risks Associated with Bed Rails

Bed rails can pose life-threatening dangers when patients become trapped between rails, between the rail and mattress, or in gaps at the rail ends or head/foot boards. Reported adverse events include:

• Entrapment leading to asphyxiation or strangulation.
• Fractures, bruises, or lacerations from attempting to climb over or through rails.
• Increased agitation or injury risk in patients with cognitive impairment.

Health Canada has documented numerous incidents, including fatalities, associated with bed rail use or misuse.

Recommendations for Safe Use

Healthcare facilities should adopt a comprehensive risk assessment approach rather than routine bed rail deployment:

• Conduct individualized patient assessments considering mobility, cognition, and fall risk.
• Use bed rails only when clinically justified and as part of a broader fall prevention strategy.
• Consider alternatives first: low beds, floor mats, bed alarms, improved lighting, toileting schedules, and staff supervision.
• If bed rails are used:
  • Select devices with Health Canada licensing and follow manufacturer instructions precisely.
  • Ensure proper fit, installation, and maintenance; check for gaps ≤60 mm to prevent head/neck entrapment.
  • Use gap fillers or enclosed bed systems when needed.
  • Regularly monitor patients and remove rails if no longer necessary or if they increase risk.

Regulatory and Reporting Obligations

• Bed rails are Class I or II medical devices in Canada and must be licensed.
• Facilities must report serious incidents (death, serious injury) involving bed rails to Health Canada via the Mandatory Problem Reporting system.
• Manufacturers must investigate complaints and report safety issues.

Practical Advice for Caregivers

• Train staff on entrapment risks and safe bed configurations.
• Document rationale for bed rail use in patient care plans.
• Review bed rail policies regularly and audit compliance.
• Educate families about risks and alternatives to reduce pressure for routine rail use.

This guidance supports a restraint-free care philosophy where possible, prioritizing patient dignity and safety through individualized, evidence-based decisions. Full recommendations, risk assessment tools, and incident reporting details are available on the Health Canada bed rails fact sheet page. Bed Rails in Hospitals and Nursing Homes – Fact Sheet - Canada.ca