Which bed designs and patient characteristics increase bed rail use?

Abstract

Background: the design and use of bed rails has been contentious since the 1950s with benefits including safety, mobility support and access to bed controls and disadvantages associated with entrapment and restraint. Objective: to explore which bed designs and patient characteristics (mobility, cognitive status and age) influence the likelihood of rails being used on UK medical wards. Method: the use of rails was surveyed overnight at 18 hospitals between July 2010 and February 2011.Results: data were collected on 2,219 beds with 1,799 included (occupied). Eighty-six percent had rails attached; 52% had raised rails (42% had all raised). Adjusted logistic regression results suggest a significantly increased likelihood of rail use for (i) electric profiling beds and ultra low beds; (ii) >80 years; (iii) described as having any level of confusion or mobility impairment. These variables together explained 55% of the variance in rail use. The most frequently mentioned reason for raising rails was 'to prevent falls from the bed' (61%) especially for patients described as confused (75%). Conclusion: there were indications that rails were being used inappropriately (as a restraint) for both confused patients and those needing assistance to mobilise.

High frequency of potential entrapment gaps in beds in an acute hospital

“…About one-third of the beds examined in this study were EP beds, and this is broadly consistent with the bed mix in the hospital as a whole. This rate is much lower than the average of 81% in a UK survey of 18 hospitals, although the rates in individual hospitals in that survey ranged from 34 to 100% [13].…”

Reducing inpatient falls: Human Factors & Ergonomics offers a novel solution by designing safety from the patients’ perspective

“…There are predictable and foreseeable interfaces and interactions with the bed rails, bedside table and walking aids. If designed using a patient's perspective there will be preferred options, for example the bed rails should both support mobility both in bed (turning and repositioning) and transferring in/out of the bed (Hignett et al, 2013) and the environment should support 'furniture walking' to replicate behaviour in the home. When sitting in a bedside chair, the table should be located at the side of the chair rather than in front (blocking egress) as 'the biggest danger of current bed/table design is catching your feet on the bed/table feet' .…”

Segurança Do Paciente Idoso Hospitalizado: Uma Revisão Integrativa

“…Assim, as quedas estão associadas a causas multifatoriais, envolvendo tanto os fatores intrínsecos (alterações do estado mental, uso de vários medicamentos, história anterior de quedas, uso de dispositivos para auxílio de marcha, maior tempo de hospitalização, incontinência fecal/urinária, alterações visuais, e patologias como osteoporose e arritmias cardíacas), como os extrínsecos (ausência de material antiderrapante no piso, cama sem grades, cama alta e ausência de barra de segurança) (22)(23)(24)(25)(26)(27)(28) .…”

“…Daí a importância da prevenção de delirium, para evitar a ocorrência de quedas (24) . Como medidas essenciais de prevenção de quedas em idosos hospitalizados, são ressaltadas o amplo conhecimento dos enfermeiros em relação às características funcionais do idoso e o histórico de doenças e quedas anteriores, realização de adaptações ambientais através da instalação de barras de segurança, iluminação e ventilação adequadas, retirada de objetos que se tornem obstáculos durante a caminhada do idoso, utilização de camas mais baixas e de grades laterais levantadas nos leitos, quando necessário (25)(26)(27)(28) .…”

“…Assim, é necessária avaliação criteriosa do uso das grades no idoso com estado cognitivo alterado, pois caso esteja com mobilidade suficiente poderá contribuir para o aumento de chances de cair e de ferir-se mais gravemente (25) . Portanto, ressalta-se a necessidade de avaliação pelos enfermeiros dos fatores de risco desde a admissão do idoso no hospital até a alta, bem como a implementação de estratégias de prevenção de riscos, proporcionando segurança à clientela idosa internada com suas vulnerabilidades durante sua permanência no ambiente hospitalar.…”