AN OVERNIGHT SURVEY OF THE USE OF BEDRAILS

1
AN OVERNIGHT SURVEY OF THE USE OF
BEDRAILS Shanahan D1 Evans AM2 1Consultant Nurse
2Research and Development Nurse Cardiff and Vale
NHS Trust
Background
To ensure that bedrails are appropriately used
to reduce the risk of patients accidentally
falling or rolling out of bed and are not used as
a form of restraint the National Patient Safety
Agency advised all NHS Trusts to audit the
overnight use of bedrails to inform the develop
a policy for their safe and effective use.
Aim
Method

• To detail the numbers and types of bedrails in
  the Trust.
• To determine the location, demographics and
  characteristics of the patients where bedrails
  were in use.
• To undertake a preliminary exploration into the
  reasons staff gave for their use.

• A night time observational audit of every third
  occupied bed in adult in-patient areas (excluding
  adult mental health and obstetrics) and patients
  in the community.
• Nurses questioned regarding patient
  characteristics and the reasons that the bedrails
  were in use.

Results
Sixty six in-patient areas audited. 564
in-patient beds and 17 community beds (n581)
BEDRAIL USE BY LOCATION

• 22 (n 124) of wards use a bedrails assessment
  tool
• 61.5 (n347)of wards use a falls risk assessment
  tool
• 73 of beds occupied by patients 65 years or
  older
• Of the patients with bedrails in full use 82
  were over 65 years
• Using the MHRA Safe Use of Bedrails Guide as a
  reference 77 (n447) of the beds appeared to
  have bedrails fitted correctly. In some areas the
  footboard to rail-end gap did appear at times to
  be outside of these recommendations

• THE REASON STAFF GAVE FOR DECIDING TO RAISE THE
  BEDRAILS
• Bedrails used
• Patient was considered at risk of rolling out of
  bed 41 (n123)
• To stop the patient getting up as they are at
  risk of falling 25 (n73)
• The patient being confused 13 (n39)
• Bedrails not used
• The patient did not need them 91 (n269)
• The patient was at risk of climbing over the
  bedrails 4 (n12)
• Confusion was cited on only one occasion

CHARACTERISTICS OF THE PATIENTS IN AUDITED BEDS
Main Findings
Future Plans

• Of the sample surveyed 38 of patients had a full
  set of bedrails raised at night compared with the
  NPSA findings of 26.
• The majority of patients who a full set of
  bedrails raised were unable to walk, unable to
  leave bed or needing help from nurses to walk or
  transfer.
• The majority of patients who had partial bedrails
  raised were unsteady when walking although did so
  independently.
• Of the patients with identified mobility problems
  86 of patients had bedrails raised compared with
  the NPSA findings of 93.

• Development of a policy for the safe and
  effective use of bedrails
• Education strategy to disseminate these evidence
  based practice guidelines
• Introduction of a falls risk indicator in
  conjunction with the Trust Falls Prevention and
  Intervention Guidelines
• The development of a mechanical restraint policy
• Re audit to evaluate the impact of the policy on
  clinical practice.