Crash mats rather than guard rails?

It’s my understanding that guard rails tend not to be used as there’s a risk of the person attempting to climb over them, falling and injuring themself. In my DF’s nursing home they lower the bed to the floor and put crash mats either side to prevent that happening. It’s more common with residents who forget that they can’t walk.

Can't advise on at home but DM was briefly in a nursing home for palliative care.

Apparently some homes have a policy of no rails but bed low and crash mats. Luckily this home did not and she was permitted rails with webbing sides. This enabled her to be at the 'right' height, access her overbed table etc etc.

They aren't allowed to trap them, that's only for prisoners or people in psychiatric units.

Also, rails are statistically more likely to causes injury as the person may attempt to climb over them, resulting in a fall from a higher height, or bum shuffle/scoot down to the bottom of the bed, tip forward and face plant on the floor.

Crash mats are the lesser of all the evils.

Yes I do.

Mum wasn't allowed rails because she 'could have attempted to climb over them' so they wete considered more dangerous than having a pressure mat that alerted the nurses desk that she'd attempted to get out of bed.

Before she was officially diagnosed with dementia we decided to give her respite in a private care home, a few times a year for a couple of weeks. She loved the care home, to her it was like stopping in a hotel on holiday, three meals a day, plenty of activities and people to talk to. She was still mobile at that point. However, whilst there she rolled out of bed, we think it'sbecause she'dgone from a King sized bed to a single. Luckily she didn't hurt herself but we bought guard rails after being told the home would not supply them. The ones we bought fitted under the mattress and only stopped the top part of her body falling out so she could still get out of bed but we felt it would prevent her rolling out of the bed.

They may allow these instead of full length guard rails.

Guard rails are dangerous. They are an entrapment hazard, and have been associated with deaths in a home enviroment. They are also a risk should the bed user attempt to climb them and fall (much more common than you'd think). They are a also a deprivation of liberty, so their use in care homes must be carefully documented.

A bed that can be lowered and surrounded by crash mats is considered much safer as the risk of injury is reduced and a pressure sensor can be set up so an alert given if a person rolls out of bed. It's also a lot easier to get someone back into bed from a crash mat and low bed - they can just be transferred back on.

My dad had crash mats and a low level bed when in the hospice before he died. He had an issue with falling/climbing out when he had guard rails. I had in mind the kind of crash mats we used in school PE, but these were massive 4 foot deep ones. Much safer.

The hospital beds can be moved right down so they're very close to the floor.

As your mum is mentally aware & not confused, then look at trying to rent the most modern type of hospital bed (used where I work) which has 4 thick plastic ‘sides’ - rather than guard rails with bars - they are so much safer in that it would be very difficult if not impossible for a patient to get caught up in them.
Obviously for a confused patient you still would keep the sides down as they may climb over them.
These beds can go really low in height.
The mattresses on these beds are automatically designed to prevent pressure sores too, although there is a pump that can be added to the bed for very high risk patients.

I think there are companies that you can rent hospital beds from online. An occupational therapist would be able to help.

I worked in an NHS trust where someone got trapped by bedrails and died. We in my new trust rarely use them.

When my Dad was in a nursing home with dementia, he gad the mats as he was likely to get his legs over the rails which was mire problematic. They also had is bed lowered to reduce the height in the event of a fall. It was the best situation for him.

I’m a community OT and the system will not physically allow us to order bed sides if the tick box risk assessment says they are mobile. There are at least 2 risk assessments to complete before ordering and then risk assessments after review. It doesn’t sound like your mum is mobile at the moment but there is still a risk she could try and get herself out - as you say people can be very determined and not always be able to think through the risks of getting over the rails.

The guidance to all healthcare professionals is here:

https://www.gov.uk/guidance/bed-rails-management-and-safe-use

If I prescribed bed rails against this policy and something happened then my registration would be at risk.

We would always prescribe a floor bed with mats and a motion detector as a preferable alternative to bed rails or have watertight clinical reasoning if not.

The bed that is provided at home will go down low to the floor when she in the room unattended, then the crash mat will be in place in case DM makes her way out.
Much safer than bed rails.

Yeah this is true I’m a nurse in hospital and if a patient is high falls risk we can get in trouble for using them as they can lead to more damage if a patient falls as they can climb over them or the way they will get out of bed can lead to worst outcomes than without them. Entrapment usually refers to patients getting trapped between the bars if they’re low bmi in weight. We use the beds low down to the floor

There is also a risk with rails of items of clothing trapping the person.

These policies used not to be in place. My grandma climbed over the cot sides of her bed in hospital, falling and breaking her hip. Which ultimately led to her death. There is very good reason that they are now generally avoided.

We use bed rails for residents with less mobility and to stop them falling/rolling out of bed.
If resident is more mobile we lower bed with a crash mat .
We cannot legally use restraint.