Under federal law, side rails are a safety device. In a nursing home setting, side rails can only be used if a physician orders their use.

In the mid-1990s, the Detroit Free Press undertook an investigation into deaths caused by side rails primarily by what is known as “positional asphyxia.” Positional asphyxia occurs when an individual, typically smaller in stature, manages to wedge him or herself between the mattress and side rail causing death as a result of asphyxiation. The phenomena of positional asphyxia via side rail was well documented in an article in the Journal of the American Geriatric Society in 1997 written by Minnesota geriatric physician Dr. Steven Miles.

Many times, people who are agitated or confused will attempt to climb over side rails which often results in catastrophic fractures which can lead to premature death.

Side rails can certainly be used safely and appropriately. Use of side rails requires an appropriate assessment and careful consideration of the needs of the patient in a hospital setting or a resident in a nursing home.Despite their appearance, side rails many times pose a greater risk of injury to a person in a nursing home or hospital bed than not using them.