Exploring the use of bedrails when used to support adults: A scoping review.

<ns3:p>Background In the UK, concerns regarding the safe use of bedrails, especially in nursing homes and a person’s own home, prompted a National Patient Safety Alert in August 2023. A scoping review was conducted to identify and map the literature relating to bedrail use in hospital and community settings and identify future areas of research. Methods The scoping review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Scoping Review guidelines. The search was conducted using MEDLINE, EMBASE, EMCARE, COCHRANE, BASE, CINAHL, and Google Scholar. Two reviewers independently contributed to screening. Data extraction included clinical drivers of bedrail prescription, prevalence of use, and causes of harm. Findings were reported narratively. Results The scoping review identified a heterogeneous and predominantly descriptive evidence base relating to adult bedrail use, focused largely on inpatient and long-term care settings. Evidence was most developed at the micro-level, where audit-based studies demonstrated strong associations between bedrail use and patient characteristics, particularly immobility. A consistent association was also identified in UK inpatient settings between bedrail use and patients described as very confused. In contrast, clinical rationales for bedrail use, including falls prevention and prevention of bed exit were frequently reported but poorly defined and inconsistently operationalised. Evidence relating to meso- and macro-level drivers of bedrail use, including organisational culture, policy, and national guidance, was limited and largely narrative. Studies reporting the impact of harm reported inconsistent findings, with serious adverse events primarily identified through incident and national surveillance data. Comparative evidence evaluating alternatives to bedrails and user experience was sparse. Conclusion Bedrail use continues in the context of limited empirical evidence, significant uncertainty, and ethical and medico-legal complexity. Further research using methodologies capable of addressing contextual and ethical factors across care delivery settings is needed to better inform practice and policy.</ns3:p>