Coventry Bed Rail Use (CBRU) Risk Assessment Tool Resource Pack

The Problem

Bed rails are used in all health care settings and aim to reduce the risk of patients falling out of bed.  However, for some patients bed rails can be an impediment as a direct outcome from either accidentally banging against the metal rail or trying to climb over or around a bed rail.  It is, therefore, essential to identify those patients at high risk of injury from bed rail use.

The latest MHRA bulletin (2006) reports that there have been serious incidents and deaths associated with bed rail use and suggests that many of these could have been prevented by an adequate assessment of the risks involved.   NRLS data suggests that around 1,250 patients injure themselves on bed rails each year.  Fortunately most of these injuries are minor e.g. scrapes and bruises.  What is not recorded, however, is the distress and anxiety caused to patients, their relatives and staff when such accidents occur.  The distress of a member of staff in University Hospitals Coventry & Warwickshire NHS Trust (UHCW) resulting from an entrapment incident prompted a review of the bed rail use risk assessment.

The Solution

The resource consists of a CD featuring the tool enclosed in a simple and easy to read booklet, together with a quick reference card for use by staff to guide them as to the appropriate use of bed rails based on the patient’s cognitive state and level of mobility.

The CBRU starts the decision-making process by identifying those patients who are at very low risk of falling from bed and indicates that bed rail use is inappropriate.  For all other patients a CBRU risk matrix is used to assess the level of risk if bed rails are used.  From the matrix patients who are at very high risk of accidental injury if bed rails are used are identified; and guidance is given for the timing of reassessments for other patients where bed rail use may be appropriate.

The final decision about the actual use of bed rails remains with the health care practitioner who knows the individual patient and care situation.  However, the CBRU also requires that deviations from the guidance are recorded as a variance so that the reasons for the decision can be seen.

The development of the CBRU has been timely given that both the MHRA and the NPSA have recently issued revised guidance about the use of bed rails.  This included a requirement that all NHS organisations providing adult in-patient care review polices to ensure that bed rail use is appropriate.

How MidTECH helped

MidTECH assisted UHCW with the terms of the agreement between themselves and Coventry University. This allows the Trust and university to split the proceeds from sales of the pack.