We aimed to systematically identify and evaluate the empirical evidence for the use or removal of bedrails, and their effect on physical injury or falls, or any other effect, including appraising the capacity of the evidence to support the strong opinions frequently expressed in the literature. A further unadjusted prospective cohort study [ 50 ] four quality criteria met also found no significanct differences. There appear to be a number of interlocking issues that influence practitioners and policy makers. We did not identify any RCT, so the level of evidence is far less robust than in a Cochrane review or meta-analysis . However, even well designed before-and-after studies can be confounded by concurrent changes in staffing, treatment and patient case-mix [ 48 ].
It furthers the University’s objective of excellence in research, scholarship, and education by publishing worldwide. Five described injury rates in falls from bed with and without bedrails [ 14 , 52 , 54 , 63 , 65 ] but only the multi-hospital study [ 14 ] found significant differences, with falls from bed with bedrails raised significantly less likely to result in injuries, particularly head injuries see Appendix 3 in the supplementary data on the journal’s website http: May 28, Controlled trial of balance training using a video game console in community-dwelling older adults. Twelve papers described direct injury from bedrails. Healthcare organisations need to appreciate that fatal bedrail entrapment is neither random nor inevitable but can be prevented by removing outdated equipment, ensuring that all bed, mattress and bedrail combinations are compatible, maintaining equipment, and training staff to fit and use bedrails safely and appropriately [ 4 , 53 , 79 , 87—89 ].
By extending its focus beyond RCTs and the few studies where standardised outcomes can be calculated to include observational or quasi-experimental studies, it provides an inclusive analysis which allows users to see the range and the limitations of evidence often used by those advocating strongly against bedrail use. One bedrail reduction study [ 46 ] found significant baseline differences in mobility, falls history, independence and medication between the patients selected to continue using bedrails and the patients selected for bedrail reduction likely to confound the results.
Learning from patient safety incidents | NHS Improvement
The effect of bedrails on falls and injury: Data From an Year Observational Study. Approximately one-fourth of these falls are from bed [4, 1418, 19]. Removal of bedrails, addition of crash mats, hip protectors, body pillows, position alarms, moving bed next to wall. Given the emotive nature of the bedrail debate, qualitative exploration of the views of patients and staff may also be helpful. Even the eight better-designed studies [ 71345—50 ] met only between four and eight quality criteria out of a maximum of ten.
We did not identify any RCT, so the level of evidence is far less robust than in a Cochrane review or meta-analysis .
Related articles in PubMed Antimicrobial properties of a novel copper-based composite coating with potential for use in healthcare facilities. Removal of bedrails, addition of crash mats, hip protectors, body pillows, position alarms, moving bed next to wall. Negative opinion may relate to an assumption that patients dislike bedrails.
Please check for further notifications by email. In addition to effects on falls and injury, any other potential harms or benefits of bedrail use merit investigation, as does the effect of different bedrail designs, partial compared to full bedrails, alternatives to bedrails, and the role of policy or decision tools to support staff in assessing the risks and benefits of bedrail use for individual patients. Careful evaluation of the empirical evidence on the use and non-use of bedrails does not lend adequate support to the widely held and powerful views that bedrails are inherently harmful.
The single case—control study [ 49 ] five quality criteria met found that having one or more bedrails raised was associated with a significantly reduced risk of falling Table 2.
Learning from patient safety incidents
Bedrails are marketed as safety devices to reduce patients’ risk of falling from bed. Because a perceived risk of falls is the nurses’ main rationale for providing bedrails [1, 4, 5], it litrrature unsurprising to find that patients provided with bedrails are older, less npsq, more cognitively impaired and more likely to be incontinent than patients who are not provided with bedrails [1, 2, 1367—69]. One bedrail reduction study [ 46 ] found significant baseline revidw in mobility, falls history, independence and medication between the patients selected to continue using bedrails and the patients selected for bedrail reduction likely to confound the results.
Related articles in Web of Science Google Scholar. The design of retrospective surveys, case series, and case studies means they inherently fail to meet quality criteria, but may still provide useful circumstantial information.
Nine studies took place in hospitals [ 144749525455606365 ], nine in nursing homes [ 713454648505758 ] and six used reports from both settings [ 53reviww59616264 ]. April to September Organisation patient npa incident reports National quarterly data on patient safety incident reports Patient safety data from NHS Wales. None of these studies showed significant differences in overall injury or fracture rates litreature were likely to be underpowered to detect these, and the single significant finding that neurological observations were less likely to be recorded after bedrail reduction [ 47 ] may be a measure of nurses’ beliefs rather than of seriousness of injury.
Current practice is thus uninformed by a comprehensive and current critique of the empirical evidence on bedrails, litertaure is strongly influenced by a body of published literature with an overwhelmingly literrature emphasis.
OR of falling with bedrails 0. Although reviews of the wider literature on institutional falls or restraints [6, 15—19, 26—31] have included bedrails, the tendency is to literatkre them with studies of belt, vest, cuff or chair restraints, and existing reviews specific to bedrails [32, 33] are not systematic or recent.
The five retrospective surveys of falls from bed can only provide information on the likelihood of injury once a fall has occurred, but none supported the current orthodoxy that injury is more likely in falls with bedrails because patients will climb over them and fall from a greater height.
Retrospective cohort study comparing reported falls for patients with bilateral bedrails with patients with partial or no bedrails, utilising patient characteristic data collected in an earlier body restraint reduction study. Twelve studies described direct injury from bedrails or injury in falls after bedrail failure, ranging from fatal entrapment to minor injuries [ 1451—5355—59616264 ].
But for patients who request bedrails, or who are incapable of leaving their bed without help, bedrails are unlikely to act bsd restraint, or restrict independence.
We included combined studies of bedrail and non-bedrail restraints only where bedrail data could be separated. Overall, whilst the evidence base is of limited quantity and quality, it does not support the prevailing orthodoxy that bedrail use should be eliminated npxa strictly curtailed on the basis of bedrail effect on falls, revisw in falls or direct injury, and suggests wholesale bedrail reduction may increase the risk of falls.
Connelly, The effect of bedrails on falls and injury: Consequences of an intervention to reduce restrictive side rail use in nursing homes.