title: The effect of bedrails on falls and injury: a systematic review of clinical studies.
abstract: BACKGROUND
  around one-fourth of all falls in healthcare settings are falls from bed. The role of bedrails in falls prevention is controversial, with a prevailing orthodoxy that bedrails are harmful and ineffective.
  
  
  OBJECTIVE
  to summarise and critically evaluate evidence on the effect of bedrails on falls and injury
  
  
  METHODS
  systematic literature review using the principles of QuoRoM guidance.
  
  
  METHODS
  adult healthcare settings
  
  
  METHODS
  using the keyword, bedrail, and synonyms, databases were searched from 1980 to June 2007 for direct injury from bedrails or where falls, injury from falls, or any other effects were related to bedrail use.
  
  
  RESULTS
  472 papers were located; 24 met the criteria. Three bedrail reduction studies identified significant increases in falls or multiple falls, and one found that despite a significant decrease in falls in the discontinue-bedrails group, this group remained significantly more likely to fall than the continue-bedrails group; one case-control study found patients who had their bedrails raised significantly less likely to fall; one retrospective survey identified a significantly lower rate of injury and head injury in falls with bedrails up. Twelve papers described direct injury from bedrails.
  
  
  CONCLUSIONS
  it is difficult to perform conventional clinical trials of an intervention already embedded in practice, and all included studies had methodological limitations. However, this review concludes that serious direct injury from bedrails is usually related to use of outmoded designs and incorrect assembly rather than being inherent, and bedrails do not appear to increase the risk of falls or injury from falls.
authors.affiliation: National Patient Safety Agency, 4-8 Maple Street, London W1 T 5HD, UK. frances.healey@npsa.nhs.uk
authors.forename: Frances
authors.initials: F
authors.lastname: Healey
authors.forename: David
authors.initials: D
authors.lastname: Oliver
authors.forename: Alisoun
authors.initials: A
authors.lastname: Milne
authors.forename: James B
authors.initials: JB
authors.lastname: Connelly
mesh_terms: D000058:Accidental Falls / Q000517:prevention & control*; D000368:Aged; D000375:Aging; D001513:Beds; D006801:Humans; D012307:Risk Factors; D014947:Wounds and Injuries / Q000453:epidemiology* / Q000517:prevention & control*