Using bedrails safely and effectively in hospitals/mental health units

1. Using bedrails safely and effectively in hospitals/mental health units

2. The purpose of bedrails

3. The purpose of bedrails • Bedrails should not be used to restrict a patient who wants to get out of bed (even if the patient would be unsteady and at risk of falling once they were out of bed) • Bedrails are safety devices used to reduce the risk of patients accidentally slipping, sliding or rolling out of bed

4. How many patients fall out of bed?

5. How many patients fall out of bed? Around a quarter of all falls in hospitals are falls from bed Over one year in hospitals and mental health units in England and Wales: • Around 44,000 patients fell out of bed • This is equivalent to around 1 in every 200 patients admitted to hospitals and mental health units • Around 90 patients fractured their hip in falls from bed • Eleven patients died, mainly from head injuries

6. What’s the evidence? • Research suggests that if used for the right patients, in the right way, bedrails can reduce the risk of falls and injury • Trying to restrict or reduce bedrail use too much can increase falls • Using bedrails for everyone would not be safe - decisions about bedrails need to be based on the risks and benefits for each individual patient • If you are interested in finding out more about the evidence, you can read a systematic literature review atwww.npsa.nhs.uk

7. Who decides about bedrails? • Patients decide, if they are well enough to understand when staff explain the risks and benefits • If patients are too ill to decide, the nurse responsible for their care needs to decide if bedrails are in the patient’s best interests • Staff should discuss bedrails with relatives whenever possible, but relatives cannot take a decision for the patient

8. Deciding whether to use bedrails Some decisions about bedrails are straightforward: • Patients who are confused enough and mobile enough to climb over bedrails should not be given bedrails • Patients who want to get out of bed without help from staff should not be given bedrails But for most patients, decisions on bedrails need to be based on the risks and benefits for them as an individual

9. Deciding whether to use bedrails [If your organisation uses a decision tool – a matrix or flow chart, for example – show this on the slide or hand it out at this point]

10. Deciding whether to use bedrails:the benefits How likely is it that the patient will fall out of bed? Patients at higher risk of falling from bed include: • Patients who have fallen from bed before • Drowsy or semi-conscious patients • Patients who are blind or have poor eyesight • Patients on special mattresses • Patients with seizures or spasms • Patients operating profiling beds themselves

11. Deciding whether to use bedrails:the benefits How likely is it that the patient will be injured if they fall out of bed? • Injury from falls from bed may be more likely, and more serious for some patients than others Will not using bedrails cause the patient anxiety? • Some patients may be afraid of falling out of bed even though their actual risk is low.

12. Deciding whether to use bedrails:the risks Would bedrails stop the patient from being independent? Is the patient likely to climb over their bedrails? • Very confused patients with enough strength and mobility to climb are most at risk Will using bedrails cause the patient distress? • Although most patients are positive or neutral about bedrails, they may distress some patients who feel trapped by them.

13. Deciding whether to use bedrails:the risks Could the patient injure themselves on their bedrails? • Bedrails can cause injury if the patient knocks themselves on them or traps their legs or arms between them. • Bedrails, even when correctly fitted, carry a very rare risk of postural asphyxiation. Patients who are very confused, frail and restless are most likely to be at risk. The risk is lower than one in 10 million hospital admissions

14. Do you know how to fit bedrails safely?

15. Do you know how to fit bedrails safely? • Check the bedrails are in good repair, with no cracks or missing parts • If using detachable bedrails, always ‘mind the gap’: • Head/end of bedrail gap must be less than 6cm or more than 25cm to avoid head or neck entrapment

16. Take special care before using standard bedrails with patients of unusual body size How can the risks be reduced?

17. Split rails in certain positions could have entrapment gaps. If leaving patient unobserved, mind the gap between the split rails – less than 6cm, or more than 25 cm, to avoid head and neck entrapment How can the risks be reduced?

18. Use extra height bedrails for extra-height mattresses or overlays How can the risks be reduced?

19. Use bedrail covers or special bedrails to reduce the risk of patients knocking their legs and arms on bedrails, or trapping them between the bars How can the risks be reduced?

20. Balancing the risks Staff should continue to take care to avoid bedrail entrapment, but should be aware that in hospital settings there is a much higher risk of injury and death from falls from bed

21. Documenting decisions [describe local documentation formats and requirements here, including how staff helping a patient into bed know whether a decision has been made on whether or not to use bedrails, and how often decisions should be reviewed. Also cover any situations where bedrail use is standard e.g. in recovery, in ITU, whilst moving patients on their beds.]

22. Exercise: difficult decisions In small groups, discuss the patient case studies on your handout • Who should make the decision about bedrails? • Do the benefits of bedrails appear to outweigh the risks? • If bedrails are used, how could you use them as safely as possible?

23. Feedback from exercise

24. Find out more Any questions? • [Local policy can be found at….] • [expert advice can be sought from nurse specialist x] Lots more information and guidance can be found at: • www.npsa.nhs.uksearch key word ‘bedrails’ • www.mhra.gov.uk search key word ‘bed rails’

25. Thank you for listening