Figure 1 Examples of the different length bed rails: A full; B split; C half. Bed rails are used in all caring environments from acute facilities to nursing and residential accommodation and in private homes.
In the UK full length rails are mostly used whereas, in the USA, the predominant type of rail is the split-side rail. Split-side rails have been widely used in the USA for the last 25 years but they are relatively new in the UK.
This difference is related to the use of electric beds which have been widely used in the USA since the s. More recently in the UK hydraulic beds are being replaced with electric profiling beds. Rails are also used by patients to adjust their position by providing a handhold to assist turning and getting out of the bed.
Bed rails can also provide a feeling of comfort and security for patients and their relatives. There are preset fields for entering information about date, bed model, manufacturer, outcome, and a free text area to describe the incident.
The frequency of bed rail related reports has increased in recent years from reports between and 5 to reports between and At a workshop organised by the Medicines and Health Products Regulatory Agency MHRA , Marsden 14 presented data from the primary and community care sector including acute, residential, and private accommodation. He reported that 94 incidents had been reported to the MHRA in involving bed rails and that there have been 20 deaths in the UK involving bed rails since Parker and Miles 7 categorised three types of death: The risk of entrapment between split-side rails was not identified in their analysis.
Concerns have recently been raised in the UK about the safety of split-side rails and Wells 15 has suggested that they present a greater risk to the patient than full side rails.
The MHRA has issued six safety warnings and a device bulletin on bed rails. A study was undertaken to investigate whether split-side rails are more likely to be associated with entrapment and injury of patients than other bed rail types.
An additional aim was to establish whether there was a difference in the site of injury caused by different bed rail types and to ascertain whether the outcome of the injury death versus survival varied with type of bed rail. Reports were included where the patient was injured or entrapped in a bed rail-related event or fell to the floor when the rail collapsed.
Analysis of data After applying the exclusion criteria, the reports were coded and entered in a database.
At this stage additional information was sought with respect to the rail type. When a report included the bed model number and the bed was only manufactured with one rail option, this information was added to the rail type variable in the data. The data were then analysed for rail type full, half, split or three-quarter , position of injured patients, outcome death, injury or near miss , and area of the body trapped or injured.
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This resulted in a final total of reports which included deaths, injuries, 53 near misses, and 53 unclassified. Near misses are reported for incidents where a patient was found in a bed rail but did not result in an injury or entrapment.
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