Using bed rails safely and effectively in hospitals - children and small adults

Introduction

Wrightington, Wigan and Leigh Teaching Hospitals NHS Foundation Trust want its patients to stay safe throughout their stay while in our hospitals. The information within this leaflet has been taken from the advice provided by the Medicines and Healthcare Products Regulatory Agency (MHRA) to ensure bedrails are used safely and effectively in hospitals.

Bedrails are equipment that attach to both sides of the cot and bed/trolley to help you stay safe while you are in bed/cot or on a trolley.  The pictures below are examples of the type of cot, bed and trolley and bedrail you may see while you are in hospital.

Bedrails attached to beds can be very effective when used with the right bed, in the right way and for the right person, and will reduce the risk of patients’ accidentally slipping, sliding, falling or rolling out of bed, they are widely used for this purpose, but they are not suitable for everyone and can introduce other risks. 

Aims

Some paediatric patients in hospital are at risk of falling out of bed. This can be because of their age, size and/or complex medical needs etc., or because anaesthetics or painkillers have made them drowsy. 

Therefore, we need to ensure that each individual patient is risk assessed prior to the use of bed rails or alternative equipment supplied, to reduce the risk associated with bed rails.

National research has found that around one in 200 hospital patients fall out of bed.  Most patients who fall receive only small bumps or bruises, but some patients are seriously injured. Rarely, injuries can be fatal. 

Risks

Here are some examples of when it is not safe to use bedrails throughout your stay in hospital:

• If you are a fully independent and mobile patient, bedrails would get in your way also if there is a possibility you will try to climb over a bedrail, it is safer not to use them.
• If you are likely to be, or become, very restless in bed there is a possibility you may injure your legs on standard bedrails. Very rarely (less than one in 10 million patients admitted to hospital), patients have died after becoming entrapped in their bedrails.
• If you should become distressed you may shake the bedrails and dislodge them which can increase the risk of entrapment – poorly fitting bedrails have caused deaths where a person’s neck, chest or limbs have become entrapped in gaps between the bedrail and the bed, headboard or mattress.

Benefits

To help lower the risks, a risk assessment must be carried out by a healthcare professional to establish the suitability of bedrails.  Where possible, the Bedrails Assessment will be completed in consultation with you and or appropriate member of the family. 

However, in the event that the patient is unconscious or lacks capacity, staff will act in the best interests of the patient and will discuss the findings of the assessment with an appropriate member of the family or their carer, at the earliest opportunity.

The Bedrails Assessment will explore your mobility, condition and environment the bedrails are used in, this allows staff to make an informed decision on whether bedrails would be safe and effective to use or unsafe and ineffective. In these circumstances staff will carefully consider the benefits and risks of the use of bed rails before they are used.

The Bedrails Assessment will be reviewed and recorded after each significant change in your condition or needs (including your weight and size).

Important Information 

•  The trained staff member will fit bed rails as per manufacturers guidelines. 
• Do not alter the position of the bedrails. 
• Bedrails should not be used as a grab rail or to restrict your exit from the bed. 
• Both bedrails should be in a raised position when you are in bed. 

For paediatric patients your admitting nurse will explain how the Risk Assessment* will be used to determine whether a cot or a bed with or without bedrails will be most appropriate and why.

Reference

Medicines and Healthcare products Regulatory Agency (MHRA) Safe use of bed rails March (2020) version 3.