In our last column about the use of bedrails (see our December 18, 2007 Patient Safety Tip of the Week “Bed Rails”) we noted differing philosophies on the two sides of the Atlantic. Whereas bedrails are a scourge on the US side, they are looked at much differently in the United Kingdom.
Another recent UK paper (Healy and Oliver 2009) reviewed the issue from the standpoint of fact vs. emotion or evidence vs. opinion. Their thorough review of the literature unveils a dearth of well-done studies on the impact of bedrails on falls from bed or injuries from falls or injuries from bedrails. The limited evidence suggests that reductions in bedrail use have resulted in increased rates of falls. They also point out that some of the more frequently suggested alternatives to bedrails (such as crash mats, movement alarms, and ultra-low beds) also have an unknown impact on falls and injuries. The paper really does put in perspective how much of the debate is emotion-driven and how much is evidence-driven.
They point out that most of the bedrail entrapment problem has related to outmoded design, unsafe combinations of bedrails and mattresses, or “hybrids” (beds and bedrails that were never intended to be used together).
The article is well worth your reading to get a feel for the evidence base (or lack thereof). While it will not likely sway you one way or the other in the debate, it certainly will raise your awareness that the bedrail issue is not a cut-and-dried one. The authors also offer several practical tips and recommendations. The resources section and bibliography are excellent.
US FDA statistics show that between 1985 and 2008, 772 incidents of patients caught, trapped, entangled, or strangled in beds with rails were reported, including 460 people who died, 136 with nonfatal injuries, and 176 who were not injured because staff intervened. And, of course, the FDA site has a wealth of downloadable documents on bed safety and bedrail use.
Healey F, Oliver D. Bedrails, falls and injury: evidence or opinion? A review of their use and effects. Nursing Times 2009; 105: 26, early online publication 6 July 2009
FDA. A Guide to Bed Safety. Bed Rails in Hospitals, Nursing Homes and Home Health Care: The Facts.Updated 5/15/2009
Hospital Bed Safety Workgroup. (Brochure) A Guide to Bed Safety. Bed Rails in Hospitals, Nursing Homes and Home Health Care: The Facts.
FDA. Hospital Beds.