Bedrails. The Argument Rages On.

The use of bedrails on the beds of adult hospital patients or care home residents has been a highly emotive debate since 1984 when The Lancet editorial at the time considered their use as ‘inappropriate and outdated.’

Although since the debate the use of bedrails has declined a 2008 report suggested prevalence in UK hospitals is still up to 39% and in care homes internationally up to 71%.The most common reason given by staff for their use is falls prevention.

The National Patient Safety Agency (NPSA) reported in 2007 that whilst most falls happen when patients are mobilising around one quarter of falls are from the bed. Around 44,000 falls from bed were reported in UK hospitals during 2006 resulting in 11 deaths and 90 fractured necks or femurs. There is no single reason given for these falls. They are most likely to be as a result of a complex interaction between the individual’s physical function and general well being, mental function, medication, behaviour and their environment. However, even ‘minor’ falls-related injuries may result in considerable stress to the individual, their families and the staff caring for them, sometimes resulting in a move from independent living for the individual. With this level of harm and anxiety associated with falls from beds, it is not surprising that bedrails continue to be used in certain circumstances in hospitals and care homes.

Crash mats, movement alarms and ultra-low beds are often suggested as alternatives to bedrails, but their effect on reducing injury is unknown.

However, since 1984 many papers on the use of bedrails have automatically categorised them as a form of physical restraint. During this time they have been described by various reports as ‘unethical,’ ‘a type of physical abuse,’ ‘inherently dangerous’ and ‘depriving patients of their dignity and liberty.’ There have been a number of fatal injuries to patients/residents as a result of bedrail entrapment or bedrail failure. Between 2000 and 2006 The Medical and Healthcare products Regulatory Agency received reports of 18 deaths in care homes and three in hospitals. A significantly high number of these fatal injuries were as a result of bedrails in poor repair, outdated designs and/or systems that were not compatible with the mattress/bed frame.

Evidence in a number of papers undertaken in the 1990s and early 2000s that considered injuries to patients/residents falling from their beds before bedrail reduction and then again after suggest that bedrail reduction or elimination actually increases the number of falls. This is particularly so with patients/residents who have had a stroke or have a visual impairment. Despite this many staff have very strongly negative opinions towards bedrails. One reason for this might well be the assumption that if bedrails are in use individuals will climb over them and fall from a greater height inevitably resulting in a significantly higher level of injury or even fatality. Some may do so, but a 2001 report from the NPSA found head injury appeared significantly less likely in falls from beds using bedrails, with most falls appearing to be feet first towards the end of the bed rather than through climbing over the rails.

In conclusion bedrails are undoubtedly inappropriate for patients/residents who would be independently mobile without them. They are inappropriate for those with mental capacity who do not want them, and for those with severe levels of confusion who are mobile enough to climb over them. Bedrails should never be used routinely or unthinkingly, nor as a substitute for adequate care and observation of the patient/resident. However, where individuals request bedrails or are incapable of leaving their bed without help, bedrails are unlikely to act as a restraint or restrict their independence.

Staff should consider each situation on a case by case basis, and ensure that when bedrails are used they are in a good state of repair, fitted correctly and are compatible with the bed frame and mattress.

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