Rank: Super forum user 
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For those of you who are in the care/care home line of work I wonder if you could help clear up an issue that has become apparent following the publication of the new HSG220 2nd edition - Health and Safety in Care Homes. In the new HSG220 document the HSE state, (Chapter 5 para 11), that the gap between the bottom of the bedrail and mattress should be no greater than 60mm. However the MHRA guidance and associated risk assessment checklist on the use of bedrails dated December 2013 says the gap between the bedrail and mattress should be 120mm max. (NB The MHRA document quoted above supersedes the version quoted in the new HSG220). So what should the figure be, <60mm or <120mm. To me that is a big difference in official guidance and the implications are considerable. Over to you.....
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Rank: Super forum user
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Take both docs as guidance only and go back to your own assessment of risk... Is there a risk that someone may get their arm or leg trapped when getting out of the bed? For me - in some cases - a 120mm gap may present a gap wide enough to trap an arm when someone is climbing from the bed (or being helped from the bed without lowering the rails which shouldn't happen but can). A trapped limb may lead to someone hanging over the side of the bed unable to release themselves - a broke limb or worse? So a narrower gap would be my choice. But in other situations the risk of entrapment (and subsequent injury) may be much less, and I'd be willing to accept the wider gap. It depends on the physical and mental state of the person using the bed, and (to a lesser extent) on their size....
Not sure what the 'serious implications' might be though?
Steve
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Rank: Super forum user
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The MHRA and HSG 220 both have statements saying that it is basically down the risk assessment of the service users needs...so I would agree with Steve...guidance.
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Rank: Forum user
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we dont allow bed rails to be fitted unless there has been an indiviual risk assessmeent completed, its not just about the gaps in the rails but also about the clients physical , mental state . it considers the need for bump guards etc. it is also important to note that nor all beds will safely take bed rails, so the type style and make of bed will also need to be considered. also be carefull as bed rails can be a generic term some times bed sticks and bed levers are included in this broad spectrum. these are a totally different animal. I have seen some horrific accidents where these pieces of equipment have been fitted innapropriately
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Rank: Super forum user 
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I'm very concerned about this. In 2011 my previous employer was prosecuted for killing somebody with bedrails in 2008, we did plead guilty. Gaps weren't an issue in this particular case, the death was down to the structural integrity of the bed and rail combination; nevertheless we spent 18 months going over every bed in the whole estate and getting everything right. Now it would appear that there is a discrepancy between what MHRA and HSE are saying. This is very bad; everybody needs to be giving the same message here, and while agreeing with what Steve & Steve and Bob are saying, I share Chas's dismay.
MHRA appear to be still quoting the old guidance, pre 2013, as their document was first issued in late 2005 (I know it says 2006, but it was 2005) and is a revision, and evidently a faulty one at that. The HSE document is quoting the newer guidance for the delivery of beds by suppliers and at manufacture. It may be 'guidance' as it is a mere BS EN, but it provide a valuable decision maker for people engaged in buying new beds, and MHRA really need to make sure their guidance agrees with the applicable standard.
Yes, we need to do assessments for everybody using rails, and that is more important than the figures in a document, but the documents are important, and they really do have to be consistent.
Presumably the serious implications are that if your rails have 120mm gaps, in good faith, and there is a serious entrapment, it wouldn't help your case to be quoting outdated guidance? Indeed, the entrapment itself would be a pretty serious implication for the person trapped.....
John
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Rank: Super forum user
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Just as a PS, and notwithstanding that the MHRA guidance appears to be still quoting the out of date BS EN; in situations like this always opt for the safest guidance on offer. Is 60mm safer (in general) than 120mm? Well, yes, it's very hard to get your leg or head through a 60mm gap, slightly easier to get it through a 120mm gap, so go for 60mm.
I also note that Steve is suggesting that the gap in the guidance may be too big, and that therefore you need to risk assess and maybe reduce it. I agree with his approach, it would be quite dangerous (in several senses) to risk assess to increase the gap; like speed limits it is to be viewed as a maximum, and really shouldn't be exceeded,
John
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Rank: Super forum user
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Thanks for the comments so far and I agree with what jwk says at #5. Our staff are told about assessing the risk and they use the MHRA guidance, (which was only updated in December 2013), as a yardstick to gauge their opinions on. Much of what has been said on training sessions over recent years now, it would seem, has to be undone as soon as possible and repeated using the HSE's criteria otherwise there are going to be differing standards being applied within one organisation................Not helpful to say the least. It doesn't help either that the HSE quote the old (pre Dec 2013) MHRA bedrail guidance as a reference. I would hate to be involved in a court case trying to explain why we do what we do with such a degree of confusing official guidance being in place. I guess that's life!
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