An additional search was made on the websites of patient safety agencies. Practical and ethical considerations mean that bedrails are not usually appropriate for a patient who could be independently mobile without them, or for a patient with capacity who does not want them, nor for a patient with severe confusion who is mobile enough to climb over them. Is there anything wrong with this page? The commonest reason given by staff for bedrail use is falls prevention [1, 4, 6, 14 ]. Large urban academic hospital in the USA, including general and psychiatric patients no other overall demographics given. Evidence-based practice requires critical appraisal, rather than partial citation. Retrospective surveys, case series, and case studies were not individually assessed since their design equates to a null score.
Twelve studies described direct injury from bedrails or injury in falls after bedrail failure, ranging from fatal entrapment to minor injuries [ 14 , 51—53 , 55—59 , 61 , 62 , 64 ]. Excess mortality following hip fracture in patients with diabetes according to age: Discontinue group pre 3. Study states reduction in patients injured NS using x 2 but p value not given. Two studies met eight of a possible total of ten quality criteria [ 46 , 48 ] two met seven quality criteria [ 7 , 47 ] and one met five quality criteria [ 45 ]. For more information, contact us at patients cpsi-icsp. The best evidence we located were four of the five before-and-after studies of bedrail reduction which met seven to eight quality criteria [ 7 , 46—48 ], whilst one before-and-after study was of lower quality [ 45 ].
Learning from patient safety incidents
Twelve studies described direct injury from bedrails or injury in falls after bedrail failure, ranging from fatal entrapment to minor injuries [ 1451—5355—59616264 ]. Related articles in Web of Science Google Scholar.
Although reviews of railw wider literature on institutional falls or restraints [6, 15—19, rwview have included bedrails, the tendency is to bsd them with studies of belt, vest, cuff or chair restraints, and existing reviews specific to bedrails [32, 33] are not systematic or recent.
None of these studies showed significant differences in overall injury or fracture rates but 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. Citing articles via Web of Science Study states reduction in patients injured NS using x 2 but p value not given.
Inevitably, these studies cannot provide information on the injuries which might have occurred if the devices had not been used, and few provide data to assess how frequently such injuries occur; one UK study [ 14 ] suggests deaths linked to bedrail entrapment in hospitals have been reported at the rate of around one per 20 million admissions, with minor direct injuries from bedrails estimated at 1, per 10 million admissions. Removal of bedrails, addition of crash mats, hip protectors, body literaturw, position alarms, moving bed next to wall.
Learning from patient safety incidents | NHS Improvement
Study states reduction in patients injured NS using x 2 but p value not given. Close mobile search navigation Article navigation. The methods employed conformed to the principles set out in Quality of Reporting of Meta-analyses guidance . Although reviews of the wider literature on institutional falls or restraints [6, 15—19, 26—31] have included bedrails, the tendency is to group them with studies of belt, vest, cuff or chair restraints, and existing reviews specific to literathre [32, 33] are not systematic or recent.
Related articles in PubMed Antimicrobial properties of a novel copper-based composite coating with potential for use in healthcare facilities. Pnsa patients without decision-making capacity, staff have a duty of care to act in their best interests [77, 78] underpinned by realistic assessment and regular review of the individual risks of bedrail use or non-use [ 79 ].
One retrospective cohort study [ 13 ] five quality criteria met found that, once adjustments were made for differences in dependency and cognitive impairment, there was no significant difference in falls or injury.
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Multi-faceted falls reduction studies including a bedrail component were included only if changes in bedrail use were described. Addition of bed alarms, non-slip floors and shoes, transfer rails, exercise.
Injury and death associated with hospital bed side-rails: Additionally, some bedrail reduction studies found patients reluctant to stop using bedrails [ 74875]. Discontinue group pre 3. We use incidents recorded in the NRLS to support learning and improvement at a national level. Current practice is thus uninformed by a comprehensive and raisl critique of the empirical evidence on bedrails, but is strongly influenced by a revies of published literature with an overwhelmingly negative emphasis.
View large Download slide. Whilst an RCT of bedrail use would present design challenges  and for ethical reasons could randomise only individuals without absolute contraindications or indications for bedrail use, the controversy is unlikely to be fully resolved until such a trial is carried out.
But for patients who request bedrails, or who are incapable of leaving their bed without help, bedrails are unlikely to act as restraint, or restrict independence. You must accept the terms and conditions. Multi-faceted falls reduction studies including a bedrail component were included only if changes in bedrail use were described. Bedrails, used to prevent accidental falls from bed, are not defined as restraints, and most patients find their use acceptable.
Of the abstracts retrieved in the initial search, 24 papers [ 7131445—65 ] were identified as meeting the inclusion criteria Figure 1. Study states reduction in patients injured NS using x 2 but p value not given. Such falls are associated with injury, fear of falling, functional impairment, prolonged length of stay, institutionalisation, complaints, litigation and excess costs [15, 22, 25]. Research and reducing inequity in healthcare.
Original paper states increase not significant unpaired Students t -test, P value not given. When things go wrong in care, it is vital incidents are recorded to ensure learning can take place.
Calculated from 9 serious injury falls representing 3. The study based on legal cases [ 60 ] relied on an inherently biased sample but suggests relatives view failure to raise bedrails as negligent.