BED SAFETY RAIL ASSESSMENT TOOL
Name:
Address:
DOB:
GP & address:
Tel no:
Source & reason for referral:
Ref no:
Assessment of service user
1
Yes
No
N/A
Yes
No
N/A
a) Is the service user able to get out of bed independently
b) If yes, will they be able to operate the rails safely?
Is there a history of falling out of bed?
2
3
4
Does the service user have poor balance/loss of sensation/altered
body awareness?
Does the service user have uncontrolled movements or seizure?
5
Is the service user restless or disorientated?
6
Is the service user at risk of falling out of bed if safety rails were not
used?
Is the service user at risk of climbing over the safety rails if they
were used?
Is the service user at risk of becoming entrapped if safety rails were
used?
7
8
Have you considered the alternatives to bed safety rails?





Repositioning bed to lower height
A fall out mattress
Side wedges / Support pillows
Bolsters
Cocoon
Assessment of Bed and Environment
Type and condition of bed
Position of bed
Mattress type & condition
Existing equipment used
IS THE RISK OF INJURY GREATER IF SAFETY RAILS WERE NOT SUPPLIED?
Yes
Assessment recommendations
No
Yes
No
Yes
No
Bed rails recommended
Bumpers recommended
Clinical reasoning for decision:
Type of equipment recommended:
Further recommendations:
Has the assessment been discussed and agreed with the user?
Has the assessment been discussed and agreed with the carer?
If no, please give details:
Assessment completed by:
Designation:
Signature:
Date:
Print name:
PLEASE FAX FORM TO THE COMMUNITY EQUIPMENT SERVICE ON 01925 236140
Following fitting please complete this section
Yes
Have the bed safety rails been fitted with reference to the manufacturer’s
instructions and the British Standard document as overleaf?
Has the carer been instructed in correct use and positioning of rails?
NB – IF BED, MATTRESS, RAIL OR SERVICE USER’S NEEDS CHANGE, A NEW BED
SAFETY RAIL ASSESSMENT SHOULD BE COMPLETED.
Designation:
Signature:
Date:
Print name:
THIS ASSESSMENT TOOL SHOULD NOT REPLACE CLINICAL JUDGEMENT.
No