Bed Rails: Protective Measures or Restraints?

Every year, patients in Australian hospitals and aged care facilities experience a large number of falls. In fact, on average there are around 4 injury-causing falls per 10,000 hospitalisations.

Falls can cause significant harm, including fractures, bruising and lacerations. These injuries prolong the patient’s hospital stay, reduce a patient’s quality of life, and even contribute to their death.

Not surprisingly, the bed is a major area where falls occur. Patients may be at risk of falling from bed for many reasons stemming from poor mobility and / or cognitive impairment. With this level of harm associated with beds, the role of bedrails in falls prevention is often debated: do they actually reduce harm? Or do they actually increase a patient’s risk of physical and psychological trauma?

Looking through the cracks

Bed rails and concave mattresses have been used as a safety device intended to reduce the risk of rolling or falling out of bed. On the surface, bed rails make sense as a physical barrier that negates fall risk. But looking deeper, bed rails pose a range of significant issues for patients and staff.

For instance, some people are at high risk of entrapment or other injury from portable bed rails. People suffering from confusion, restlessness, lack of muscle control, or cognitive impairment due to medication or a condition such as Alzheimer’s are at a higher risk of entrapment and injury.

The psychological effects of using bed are just as significant. Psychological effects such as demoralisation, humiliation, and agitation at being ‘trapped’ in bed can not only increase a patient’s likelihood of entrapment and injury, but also have an effect on a patient’s physical health.

The Australian Royal Commission into Aged Care recently uncovered accounts of the misuse or overuse of physical restraints, as well as psychotropic medication, in place of proper care measures for patients at risk of falls in aged care facilities.

Defining the limits of bed rails as a protective measure

Bedrails used to prevent an accidental fall from bed - as opposed to using bedrails to keep a patient in bed against their will - may be effective with other care measures for upholding their safe use.

For example, the appropriateness of bed rails can vary from patient to patient, depending on their conditions and overall situation. Staff have a duty of care and must decide if bed rails are in the patient’s best interests.

Risks to consider include:

  • Falling out of the end of the bed
  • Falling over the top of the bed rail
  • Becoming trapped between the bedrail and mattress
  • Trapping the head between bedrails
  • Striking limbs on bedrails
  • Getting arms or legs trapped between bedrails

Alternative methods to bed rails

There is an emerging body of evidence indicating other measures that are more effective at promoting patient safety than bed rail use.

Measures to reduce risk of falls include:

Additionally, floor level beds have been developed to reduce the risk of vulnerable patients injuring themselves by rolling out of bed.

Keystone Healthcare provide a range of low-lying beds that typically range from a height of 120mm to 820mm. They are combined with crash mats that are placed on either side of the bed, so the patient simply slides off with no impact should they roll out of bed.

Low-lying beds have full electric control, so carers can easily raise the bed to attend to the patient, and lower it again without physical exertion. The control has a safety lock so patients can be blocked from using it themselves if necessary.

The way forward

With the safe use of bed rails under contention, healthcare facilities would be wise to look at alternative options for ensuring the safety and dignity of their patients. Keystone Healthcare carry a range of innovative safety equipment that are designed to make both patient and caregiver lives easier and better.

To discuss fall safety equipment for your healthcare facility, give us a call on 1300 547 877.