Systematic reviews of health effects of social interventions: Serious injury is defined as fractures, dislocated joints, subdural haematoma, lacerations requiring suturing. Device Bulletin 06 the safe use of bedrails London: High frequency of potential entrapment gaps in beds in an acute hospital. The US studies [ 53 , 56 , 59 , 64 ] suggest an annual average of around 20 deaths through bedrail failure or entrapment across hospital, nursing home and domestic settings. Subsets of visually impaired patients [ 45 ] and patients with a history of stroke [ 48 ] experienced significantly increased rates of falls. I agree to the terms and conditions.
Resistant syndrome of inappropriate antidiuretic hormone SIADH secondary to atonic bladder in an older woman. Our search found no studies describing any effects of raised bedrails other than those on falls and injury described above. Given the emotive nature of the bedrail debate, qualitative exploration of the views of patients and staff may also be helpful. Additionally, most studies were based on reports from frontline staff, a method limited by incomplete data and under-reporting [ 14 , 19—21]. The commonest reason given by staff for bedrail use is falls prevention [1, 4, 6, 14 ]. An additional search was made on the websites of patient safety agencies.
Overall, whilst the evidence base is of limited quantity and quality, it does not support the prevailing orthodoxy that bedrail use should be eliminated or strictly curtailed on the basis of bedrail effect on falls, injury in falls or direct injury, and suggests wholesale bedrail reduction may increase the risk of falls. However, if the text of the paper is read the apparent change in serious injury occurred in an extra category not included in the results tables but defined within the text as minor head injuries where neurological observations were taken.
Every six months we publish official statistics on patient safety incidents recorded on the NRLS.
Learning from patient safety incidents
Although overall, the before-and-after studies litwrature that unselective reductions in bedrail use may contribute to an increase in patient falls, particularly in patients with stroke or visual impairment, the methodological issues mean this cannot be a firm conclusion. While patient safety alerts have always been the visible flagship of the process, we also work with our regulatory, clinical and industry partners to address issues identified oiterature incident reports.
Our search found no studies describing any effects of raised bedrails other than those on falls and injury described above. Meta-analysis was not attempted, as a recent meta-analysis on litdrature prevention in institutions identified very few papers where standardised outcome data could be extracted .
Medicine and Healthcare products Regulatory Agency. Because a perceived risk of falls is the nurses’ main rationale for providing bedrails [1, 4, 5], it is unsurprising to find that patients provided with bedrails are older, less mobile, more cognitively impaired and more likely to be incontinent than patients who are not provided with bedrails [1, 2, 1367—69].
For 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 literatre of bedrail use or non-use [ 79 ].
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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. Study states reduction in falls not statistically significant using x 2 but P value not given. Effectiveness of surface coatings containing silver ions in bacterial decontamination in a recovery unit.
We intended the review to provide a resource to inform clinical practice and to identify gaps for future research. The methods employed conformed to the principles set out in Quality revlew Reporting of Meta-analyses guidance .
Full search strategies, including the databases, websites and the full list of studies rejected with rationale are available in appendix 1 see supplementary data on the Journal’s website http: Citing articles via Web of Science Due to the large number of references, only 29 are listed below and are represented by bold type throughout the text. Details of quality criteria met by individual studies are presented in appendix 2 see supplementary data on the Journal’s website http: 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.
Most bedrail reduction studies concurrently introduced additional interventions, including hip protectors, [ 7 ] movement alarms, [ 74648 ] toileting regimes [ 47 ] and crash mats [ 746 ]. May 23, Discontinue group pre 7, post 4. Two studies met eight of a possible total of ten quality criteria [ 4648 ] two met seven quality criteria [ 747 ] and one met five quality criteria [ 45 ].
This usually happens in March and September. OR of falling with bedrails 0. Retrospective surveys, case series, and case studies were not individually assessed since their design equates to a null score.
A subsequent meta-analysis confirmed decrease in falls NS rate ratio literatuge. This complicates the existing clinical challenge staff face in balancing patient safety with the promotion of independence and rehabilitation [5, 1329, 37, 38].
Education of staff, selection non-randomised 2 by advanced practice nurse of patients to continue or discontinue bedrails, bed alarms, floor mats, low beds. 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. The full list can be found in revlew supplementary data online, on the journal website http: Email alerts New issue alert.
One study described an apparently significant reduction in serious injuries [ 47 ] but only if minor or suspected head injuries, where nurses checked neurological literaturr, were defined as serious injuries.
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Research and reducing inequity in healthcare. Additionally, some bedrail reduction studies found patients reluctant to stop using bedrails [ 74875]. It appears minor bruises and lacerations to the head were counted as litfrature injuries unless neurological observations were taken, in which case they were counted as serious injuries.