Your browser is no longer supported

For the best possible experience using our website we recommend you upgrade to a newer version or another browser.

Your browser appears to have cookies disabled. For the best experience of this website, please enable cookies in your browser

We'll assume we have your consent to use cookies, for example so you won't need to log in each time you visit our site.
Learn more

Practice comment

Decisions on bedrails must not be made through emotive arguments

  • 4 Comments

The highly emotive debate on bedrails has obscured the real issue of weighing up the risks and benefits for each individual patient, argues Frances Healey

In 1984 The Lancet published an editorial castigating the use of bedrails, suggesting that their use was as inappropriate and outdated as the use of fetters in schizophrenia’ (anon, 1984).

At that time, I was a newly qualified staff nurse, with memories of my ‘geriatric’ placement in a former workhouse fresh in my mind – a unit with caring nursing staff, but where the use of bedrails and Buxton chairs was routine.

Had I read The Lancet editorial at that time, I would probably have wholeheartedly agreed with it.

The debate has hardly become any less emotive in the years since. At the International Falls Prevention and Bone Health conference in 2007, the case for and against bedrail use was illustrated – albeit by speakers intending to provoke a reaction from the audience – by pictures of restrained and hooded prisoners in Guantanamo Bay.

It seems there is nothing quite like bedrails to provoke polarised views.

For most of my years in clinical practice, I worked with older people whose needs crossed mental health and acute hospital boundaries.

For this patient group, falls prevention was a constant concern, and balancing the risks of using or of not using bedrails was a constant challenge. So, as I moved into research, management and patient safety, the issues remained uppermost in my mind.

I had some formative experiences along the way. When I was a newly appointed ward sister, a patient in a neighbouring hospital died from bedrail entrapment. Such a distressing and lonely way to die; it was little wonder that my manager’s reaction was to send a porter to confiscate all our bedrails.

I found myself fighting to keep bedrails at least for those of my patients who were confused, restless, hoist-dependent hemiplegics on alternating pressure mattresses.

Analysing a batch of hospital bedrail policies influenced me, too. Some were excellent – but it would have been a brave nurse who dared to use bedrails in the hospital whose policy stated the devices were restraint, restraint without written consent was common assault, and this offence could be punished by a jail term of up to six months.

The aspect that made me saddest was that, for every 10 policies warning that bedrails could kill, there was barely one telling staff how they could avoid this happening.

I was also privileged to be allowed to survey bedrail use overnight in a number of hospitals, and to ask nursing staff about their reasons for using or not using them for individual patients (National Patient Safety Agency, 2007).

What was reassuring was that frontline nurses were usually making decisions based on their understanding of the wants and needs of individual patients.

However, some staff who had made perfectly sensible and justifiable decisions to use bedrails felt they had to apologise to me for making that decision.

Focus groups with patients (NPSA, 2007) also left me slightly embarrassed at how emotive the debate had become. Patients were pragmatic, and some appeared slightly amused by how seriously we took what they considered to be a minor aspect of care.

For all the experience and the emotion in the bedrail debate, what is the actual evidence? Professor David Oliver and I summarise the evidence in an In depth article.

Limited though this is, it suggests that both the ‘old school’ that advocates routine bedrail use and the ‘new school’ that advocates their abolition are equally wrong. Decisions on the risks and benefits of bedrail use can only be made case by case in partnership with individual patients.

Frances Healey is clinical reviewer for the National Patient Safety Agency

 

  • 4 Comments

Readers' comments (4)

  • The last sentence sums this up: the simple, straightforward answer is that good risk assessment in the first place will prevent the majority of adverse events related to use of siderails. In addition, the increasing availability and use of low bed technology has further complicated this issue due to the fact that if they're fitted or available some staff will insist on employing them even with the bed at its lowest height - thus defeating the object of the equipment's design. Remove the 'human' factor from the equation and things will be all right!

    Unsuitable or offensive? Report this comment

  • Hear hear. Any policy that imposes a blanket decision on bed rails is likely to be seriously flawed. The only sensible approach is to make a decision based on proper risk assessment and from an understanding that we need to be both reasonable and lawful.

    For example, it may well be unlawful to impose bed rails on a patient who has capacity to refuse them and does so. However it may well be lawful if that patient lacks capacity to decide and the bedrails represent a reasonable restriction of liberty.

    The restriction in this case must be proportionate and in the patient's best interests (hence the need for proper individualised risk assessment).

    Cheers,

    Stuart

    Unsuitable or offensive? Report this comment

  • Having read the above article, I reckon by the time that some people have sifted through all the various policies as to whether or not to employ the flippin bedrails, that all manner of scenarios may have happened to the poor patient in the bed! Whatever happened to the engagement of brain into common sense mode and the ability to come to a quick decisive decision?!

    Unsuitable or offensive? Report this comment

  • Having had many a debate about the issue of bedrails it is clear that individual assessment is the starting point. Base line decision though in my view is whether they are employed for safety or restraint. I can see no reason for their use as restraint as this is probably when the most adverse incidents have occurs?
    Buxton chairs! are they still about, I would hope not.
    I recall that I had a few debates with family members of patients whoi did not agree that cot sides should not be used. It was possible with good rational and explanation to change their thinking on this matter.

    Unsuitable or offensive? Report this comment

Have your say

You must sign in to make a comment

Please remember that the submission of any material is governed by our Terms and Conditions and by submitting material you confirm your agreement to these Terms and Conditions. Links may be included in your comments but HTML is not permitted.