The effect of bedrails on falls and injury

Falls and injury are a significant concern in healthcare and are linked to the never events. Around 1/4th of the falls in healthcare settings are from the bed. However, the literature on the role of bedrails in fall prevention is controversial and the prevailing opinion is that bedrails can be harmful and ineffective. This paper looks into the controversial issue of the efficacy of bedrails via a systematic review of the literature. A systematic literature review on adult healthcare settings was conducted using the principles set out in the Quality of Reporting Meta-analyses. However criteria for inclusion were kept deliberately broad and not limited to randomized controlled trials in research design. Keywords used for the search included restraint, restraint-physical, bedrail, side rail, cot-side, safety rail and protective device. Articles were reviewed from 1980 to 2007, on direct injury from bedrails where falls, injury from falls or any other effects were related to bedrail use. Out of the 472 papers reviewed 24 met the inclusion criteria. Three bedrail reduction studies identified significant increases in falls or multiple falls, and one found that despite a significant decrease in falls in the discontinue-bedrails group, this group remained significantly more likely to fall than the continue-bedrails group; one case-control study found patients who had their bedrails raised significantly less likely to fall; one retrospective survey identified a significantly lower rate of injury and head injury in falls with bedrails up. Twelve papers described direct injury from bedrails. OBJECTIVES To summarize and critically evaluate evidence on the effect of bedrails on falls and injury To provide a resource to inform clinical practice and to identify gaps for future research DESIGN IMPLICATIONS Fatal bedrail entrapment is neither random nor inevitable but can be prevented by removing outdated equipment, ensuring that all bed, mattress and bedrail combinations are compatible, maintaining equipment, and training staff to fit and use bedrails safely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.