Clinical Protocol for the use of Bed Rails within NHS ... · Clinical Protocol for the use of Bed Rails within NHS Northamptonshire (Provider Services) Setting Protocol PROV 11 March

Clinical Protocol for the use of Bed Rails within NHS Northamptonshire (Provider Services) Setting Protocol PROV 11

March 2009

PROV 11 Clinical Protocol for the use of Bed Rails within NHS Northamptonshire Setting v 1 Page 1 of 26


Document Management Title of document Clinical Protocol for the use of Bed Rails within NHS

Northamptonshire Setting

Type of document Clinical Protocol: Procedure PROV 11

Description Minimum standard for the assessment, ordering, fitting and maintenance of bed rails

Target audience Provider Services

Author Provider Services

Directorate Provider Services

Approved by Clinical Governance and Effectiveness Group

Date of approval 27 March 2009

Version Number 1

Next review date March 2011

Related documents PH 03 Infection Control Policy and Guidelines GOV 07 Incident and Near Miss Policy PROV 10 Policy for Managing the Risks Associated with Slips, Trips and Falls Involving Patients, Staff and Others (under review as at March 2009)

Superseded documents None

Internal distribution All Staff

External distribution

Availability All ratified policies, strategies, procedures and protocols are published on the Trust Intranet and Public Website.

Name:

David Thomas Associate Director Governance

Address:

Bevan House Kettering Parkway South, Venture Park Kettering NN15 6XR

Tel: 01536 480322

Contact details (Of main contact for this document)

Email: [email protected]

mailto:[email protected]

Clinical Protocol for the use of Bed Rails within NHS Northamptonshire (Provider Services) Setting

Contents Page no: 1. Introduction 4 2. Specific Aim 4 3. Objectives 4 – 5 4. Scope 5 5. Supporting Data & Definitions 5 6. Responsibilities 5 – 6 7. Specific Detail / Key Points

7.1. Potential Hazards / Dangers 7.2. Risk Assessment 7.3. Alternatives to bed rails

7 7 – 8 8 9

8. Training 9 9. Monitoring & Evaluation 9 – 10 10. Cross Reference Policies & Bibliography 10 11. Acknowledgements 10 12. List of Appendices

• Appendix 1 Bed Rails Risk Assessment Flow Chart Tool • Appendix 2 Bedrails Risk Assessment

Part A Patient Assessment Checklist Part B Equipment / Fitting Checklist

• Appendix 3 General Guidance on the Use of Bed Rails • Appendix 4 Information for Patients, Relatives and Carers • Appendix 5 Impact Assessment

11 12 – 24


1. Introduction

Bed rails are used to prevent patients from falling from bed and sustaining injury. They are not designed or intended to limit the freedom of people by preventing them from leaving their beds voluntarily, nor are they intended to restrain people whose condition disposes them to erratic or violent movement. Bed rails must not be used as a means of restraint and should be used as the exception versus the rule.

1.1. It is recognised that as well as having many proven benefits the use of bed rails

does have some inherent dangers. Nationally, numerous serious and fatal injuries have been reported through the misuse or incorrect selection of bed rails for specific patients.

1.2. The use of bed rails for patients will only be issued in exceptional circumstances

and must be decided only after a suitable and sufficient risk assessment has been undertaken. A competent person with the necessary training, knowledge and experience must complete a risk assessment.

1.3. The use of bed rails does not replace the need for adequate nursing

observation and escorting patients who are at risk of falling. 1.4. Even though some beds have integral bed rails, the principles of patient

assessment and safety detailed in this document still apply. 2. Specific Aim

2.1. In conjunction with the Bed Rails Risk Assessment Flow Chart Tool (Appendix 1) and Risk Assessment Check List (Appendix 2), this document provides structured procedures on the use of bed rails in order to improve patient comfort and wellbeing by helping to prevent what are sometimes avoidable falls from bed often experienced by vulnerable patients. Please refer to General Guidance on the use of Bed Rails (Appendix 3).

3. Objectives

3.1. Bed rails are used extensively to prevent patients falling out of their beds. However, there have been a number of adverse incidents involving bed rails that have led to injury and in some cases death. This Protocol has been developed to support staff to identify patients who require bed rails and assist in the correct selection, fitting, positioning and maintenance of bed rails.

3.1.1. To provide the necessary guidance on the risks to, and benefits for, the patient

when using bed rails. 3.1.2. To reduce harm to patients caused by falling from beds or becoming trapped in

bed rails.

3.1.3. To support patients and staff to make individual decisions around the risks of using and of not using bedrails.



3.1.4. To clarify the responsibilities of the qualified nurse (inpatient) or prescribing practitioner (community) to carry out a full risk assessment.

3.1.5. To suggest alternatives to the use of bed rails where their use may prove more

hazardous to the patient than not using them.

3.1.6. To ensure compliance with guidance issued by Medicines and Healthcare Products Regulatory Agency (MHRA) and National Patient Safety Agency (NPSA).

3.1.7. To limit the quantity of staff competent and eligible to prescribe bed rails

resulting in appropriate provision and accountability. 4. Scope

4.1. This document is for all staff that have a responsibility for patients under their care who have been identified as being at risk of falling out of bed. These staff are responsible for considering the patient’s risk and documenting whether a full bed rails assessment is required or not (Appendix 1) and for completing the full (Part A and Part B) Bed Rails Risk Assessment Check List (Appendix 2) if bed rails are required.

5. Supporting Data & Definitions

5.1. Patients: Adults and children. 5.2. Bed Rails: (Also referred to as cot sides, bed rails and bed guards) hinged or

pivoted safety bars attached to or forming part of the bed frame and used in such a way that they can prevent falls from bed. They can be folded to permit patient care to be given or for the patient to get in and out of bed.

5.3. Entrapment: The accidental trapping of a limb or other body part between the

framework of the rail or between the rail and the bed frame.

5.4. Overlay Mattress: A pressure relieving device laid on top of the existing mattress where patients have been identified as having an increased risk of pressure sore damage.

5.5. Bumpers: Padded accessories or enveloping covers primarily used to prevent

impact injuries but can also reduce the potential for limb entrapment when securely fixed to the bed or rail.

5.6. Authorised Prescriber: Clinical Member of Staff who has undertaken the

appropriate NHS Northamptonshire (Provider Services) Training and who are deemed competent to prescribe Bed Rails.

6. Responsibilities

6.1. The Chief Executive (Designate) and Provider Services Board are accountable for ensuring the implementation of the bed rails protocol within NHS Northamptonshire (Provider Services), this function is delegated to service managers and clinical leads.


6.2. NHS Northamptonshire (Provider Services) has a responsibility for ensuring, so far as is reasonably practicable, that suitable and sufficient equipment is available for staff to care for patients safely.

6.3. NHS Northamptonshire(Provider Services) will provide sufficient training for

qualified staff to be competent in the risk assessments required.

6.4. Only Authorised Prescribers will be able to prescribe Bed rails for use in either an inpatient or Community setting following receipt of a fully completed risk assessment (Appendix 2).

6.5. The ward / department manager is responsible for highlighting, through

general risk assessment which equipment is needed when purchasing. 6.6. Qualified staff will access training and keep records of their attendance. 6.7. The qualified staff member accountable for the patient’s care will carry out the

risk assessment to determine the need for bed rails or other specialist equipment, seeking advice as necessary. The completed assessment should then be used to decide if the patient is suitable for bed rails or if an alternative measure is required.

6.8. The qualified staff member caring for the patient may use alternative measures

to minimise the risk to the patient. They are responsible for completing an incident form as per the Incident and Near Miss policy if there are any problems in achieving the safety measures identified as necessary.

6.9. Staff must, at the earliest opportunity, discuss with the patient (where possible)

and / or their relatives / carers the risks of the patient falling out of bed and of the consequent need for bed rails. See guidance (Appendix 1 and 2) and Information for Patients, Relatives and Carers (Appendix 4). The patient / relative /carer must sign the Bed Rails Risk Assessment Check list (Appendix 2 Part B) to show involvement in the decision making process and agreement to conditions of equipment issue.

6.10. Rails must:

6.10.1. Inpatient / Ward Setting – be fitted by the qualified staff member caring for the

patient and used in accordance with the manufacturer’s instructions. If unsure regarding use of bed rails advice must be sought from the individual’s Line Manager.

6.10.2. Community Setting – be supplied, delivered and fitted by the Community

Logistics Service and used in accordance with the manufacturer’s instructions. If unsure regarding use of bed rails advice must be sought from the individual’s Line Manager.


ps between bed / mattress and bed rails ch side of the bed

7.1.4. To minimise the risks from any hazards and dangers, the Bed Rails Risk

7.1.5. Fitting of bed rails correctly is essential if accidents are to be avoided and

d

• That there is no gap between the lower bar of the bed rails and the top of

• ge, that there is no risk of

• at the end of the bed rails and the headboard/foot of the bed

• oid entrapment of their hands whilst fitting the bed

• e fitted, bed rails should be checked to ensure that all locking mechanisms are properly engaged to secure the side rail to the bed frame after each use

7. Specific Detail / Key Points 7.1. Potential Hazards / Dangers 7.1.1. Those members of staff who undertake assessments must be aware of the

Potential Hazards and Dangers involved in the use of bed rails to ensure all relative aspects are addressed during the process. These risks / dangers include but are not restricted to:

7.1.2. Patient related:

• Patients climbing over / around the bedrails, especially confused or agitated

patients • Patients with uncontrollable involuntary movements • Patients fear of confinement by bedrails • Patients able to unlatch / push away bed rails • Patients hitting or lacerating their body on the bed rails • Entrapment of a body part - especially the head and limbs • Patients who have cognitive difficulties e.g. a diagnosis of dementia or learning disabilities • Patients with communication difficulties

7.1.3. Equipment related:

• Mechanical failure of bed rails • Large spaces or gaps between rails

Incompatibility of bed rails with the be• d/mattress as per manufactures instructions • Insecure or br oken fittings • Mattress overlay reducing effective height of bedrails (extra height bed rails must be used) • Inappropriate ga• Using only one bed rail – there should always be one on ea

Assessment Check List must be completed (Appendix 2).

should normally be undertaken by trained fitters. When fitting and using berails the following things need to be ensured:

the mattress that could cause entrapment If the mattress compresses easily at the edentrapment That the gapwill not allow entrapment Staff must take care to avrail Onc


ed fitted

ed again

7.2. Ris

7.2.1. ed rails are used to prevent patients from falling from bed and sustaining designed or intended to limit the freedom of people by

preventing them from leaving their beds voluntarily, nor are they intended to nt. ally

ce

7.2.2.

. This will determine whether their use is the most appropriate method of patient

7.2.3.

ally indicated, will be assessed for the need for bed rails using the Bed Rails Risk Assessment Flow Chart Tool (Appendix 1).

fit or not d

7.2.4.

• The Patient

7.2.5. s Risk Assessment: Equipment / Fitting Checklist is to be

made to issue bed rails and covers and is to assess:

on of bedrails - including their fitness for purpose (Appendix 2)

7.2.6. each significant change in the s this

will be a minimum of every two weeks. For community based patients, the

7.2.7. ls

• Bed rails must not be used as handholds when moving beds. If a bwith a bed rail is moved or the mattress is disturbed, the bed rail fitting should be check

k Assessment

Binjury. They are not

restrain people whose condition disposes them to erratic or violent movemeBed rails must not be used as a means of restraint. Bed rails are not generdesigned to be used as grab handles, which are aids for getting in and out ofbed and moving around when in bed and use in this way may make them unsafe (Appendix 4). However some manufacturers, where bed rails are integral to the bed show the bed rails as being able to be used to aid movement i.e. helping patients to stand. Staff should explain the importanof this difference to patients and their next of kin and carers.

Bed rails should be used with care and only after a full, documented risk assessment has been carried out for each patient (Appendix 2)

management in each case.

All patients admitted as inpatients to the NHS Northamptonshire and Community patients as clinic

This will ensure that the initial decision and reasons behind whether toto fit bed rails are considered for all patients. If the assessment shows a neefor bedrails then the Bed Rail Risk Assessment Check List (Appendix 2) must be carried out. This assessment covers both intrinsic and extrinsic factors.

Part A Bedrails Risk Assessment: Patient Assessment Checklist is to assess:

• The Care Environment

Part B Bedrailcompleted if the decision is

• Bed, mattress, accessories and bed rails • Conditi

Risk assessments should be reviewed afterpatient’s condition or any incident relating to safety in bed. For inpatient

strategies and information must be given to the patient, carer or relative by Prescriber to enable them to access reassessment or review of both patient and equipment (Appendix 4) and documented accordingly.

Relatives / Carers will be given an information sheet about the use of bed rai(Appendix 4)


7.3 Alternatives to bed rails

7.3.1 suggest there are alternative ways to care for patients without rails. They include, but are not restricted to:

• Beds that lower to the floor ed at their lowest setting

ents at high risk of falling to break a patient’s fall

8. Train g

8.1. The NHS Northamptonshire will provide training for clinicians who have a ibility for assessing, prescribing and issuing bed rails and consequently me Authorised Prescribers. This training will include:

8.2. petency

cal Incidents relating

9. ni

the following areas:

and equipment provided:

tly basis or more frequently if a patient’s situation changes using the Bed Rails Risk

en to ess

t and equipment (Appendix 4) and documented accordingly

•

• onitored by Provider Services Incident / Near Miss reporting system and reported on routinely

The M.H.R.A. resorting to the use of bed

• Concave mattresses • Tucked in sheets and blankets

• Variable height beds us• One - to - one monitoring of pati• Soft cushioning on the floor • Patient sensor alarms (to alert staff that a patient has moved from a bed or

chair) • Placing the patient on special observations • Positioning a patient in view of the nurses station • Netting or mesh bed sides

in

responswill beco • Assessment of risk for staff evaluating potential need for bed rails • Appropriate prescription and aspects of maintenance Cleaning and fitting of bed rails •

Training will be updated every year to ensure clinical practice and comis maintained. This is to ensure that the potential for Clinito bed rails is as low as possible

Mo toring & Evaluation

Monitoring and evaluation covers 9.1.

• Clinical provision - patient

- Inpatients will have provision reviewed on a fortnigh

Assessment Check List (Appendix 2)

- For community based patients, strategies and information must be giv the patient, carer or relative by the Prescriber to enable them to acc reassessment or review of both patien

Training needs will be monitored by individuals, their managers and the NHS Northamptonshire Training Department Clinical Incidents will be m


ing to location of

•

there nt staff able to risk assess and prescribe for the provision of bed

•

cs Service. Managers will h updates to staff

Department with details of staff movements

10. Cross r

e products Regulatory Agency

• Hardware will be monitored by Community Logistics Service (Medical Loans Department) or the inpatient wards accordequipment Clinical process auditing will be implemented by ward / departmentmanagers

• Departmental managers will need to succession plan to ensure that are sufficierails A list of Authorised Prescribers will be held: - For community: by the Community Logisti

regularly provide the Community Logistics Service wit movements

ts: held by each Ward Manager who will regularly update - For Inpatien the Training

eference Policies & Bibliography

• Department of Health - Medicines and Healthcar(MHRA) : Device Bulletin Safe Use of Bed Rails MDA DB2006 (06) December

82006 http://www.mhra.gov.uk/Publications/Safetyguidance/DeviceBulletins/CON202534

• GOV07 Incident and Near Miss Policy http://www.foi.northants.nhs.uk/Content/Policies_and_procedures/Governance/index.jsp

• PH 03 Infection Control Policy and Guidelines

http://www.foi.northants.nhs.uk/Content/Policies_and_procedures/Public_Health/index.jsp

National Patient Safety Agency (

• NPSA). Patient briefing: Using bedrails safely and effectively 26 February 2007 http://www.npsa.nhs.uk/nrls/alerts-and-directives/notices/bedrails/


• NPSA): The third report from the PatieObservatory; Slips, trips a

nt Safety nd falls in hospital. PSO/3

http://www.npsa.nhs.uk/nrls/alerts-and-directives/directives-guidance/slips-trips-falls/


• NPSA) Safer Practice Notice 17: Using bedrailssafely and effectively 26 February 2007

http://www.npsa.nhs.uk/nrls/alerts-and-

directives/notices/bedrails/

knowledgements 11. Ac

Community Equipment Service - Guidance on the safe

06 d rails

• Hospitals of Leicester NHS Trust - The Use of Bedrails in Adult

• Bedfordshire and Lutonuse of Bed Sides

• Daventry and South Northants - Guidelines for the use of side rails • Kettering General Hospital - Protocol for the Reduction of Falls Within the

Hospital • Norfolk PCT – Assessing and Prescribing Bed Rails Policy March 20• Northamptonshire Healthcare Trust - 14.1 Procedure for the safe use of be

UniversityPatients. Policy and Guidance

http://www.mhra.gov.uk/index.htm



http://www.foi.northants.nhs.uk/Content/Policies_and_procedures/Governance/index.jsp




http://www.npsa.nhs.uk/


http://www.npsa.nhs.uk/nrls/alerts-and-directives/notices/bedrails/

http://www.npsa.nhs.uk/nrls/alerts-and-directives/notices/bedrails/


http://www.npsa.nhs.uk/nrls/alerts-and-directives/directives-guidance/slips-trips-falls/




12. s

• Assessment Flow Chart Tool rails Risk Assessment

Part A Patient Assessment Checklist

se of Bed Rails • Carers

Li t of Appendices

Appendix 1 Bed Rails Risk• Appendix 2 Bed

Part B Equipment / Fitting Checklist • Appendix 3 General Guidance on the U

Appendix 4 Information for Patients, Relatives and

Clinical Protocol for the use of Bed Rails within NHS Northamptonshire Setting v 1 Page 12 of 26

PROV 11

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Appendix 2

Bed Rails Risk Assessment Part A Patient Assessment Checklist This tool should be used in conjunction with Appendix B – General Guidance on the Use of Bed Rails and the clinician’s own professional and clinical judgement.

Complete the information below NB: a patient label may be used as appropriate for the relevant information

Name: DOB: Address: GP:

NHS no: Date of Assessment Assessor (Print name):

Base/Unit: Risk assessments should be reviewed after each significant change in the patient’s condition or any incident relating to safety in bed or as a minimum of every two weeks for inpatients. The continued use (or not) of the bed rails should be recorded in the care plan and appropriate documentation. If a patient, relative/carer insists on bed rails being used, even after any potential risks have been explained, complete and follow the outcome of the risk assessment documenting their reasons and resulting action taken.

If a patient is deemed to be at risk of falling out of bed consider the following: YES NO 1 Does the patient have dementia, confusion, learning

disability, agitation, unable to comprehend or are they distressed?

Consider entrapment issues & alternatives

Continue assessment

YES NO 2 Does the patient have epilepsy or other involuntary movements, which may cause entrapment? Consider

entrapment issues & alternatives

Continue assessment

YES NO 3 Is the patient at risk of climbing over the bed rails? Consider alternatives

Continue assessment

YES NO 4 Does the patient have altered sensation? Consider entrapment issues & alternatives

Continue assessment

YES NO 5 Does the patient have a very small or very large head or body that may increase the risk of entrapment in the bed rail and side of the mattress?

Consider entrapment issues & alternatives

Continue assessment

(CIRCLE AS APPROPRIATE)


Affix Patient Label Part A Patient Assessment Checklist cont.

YES NO 6 Does the patient’s physical or clinical condition increase the risk of entrapment? Consider

entrapment issues & alternatives

Continue assessment

YES NO 7

Has the patient got an indwelling catheter in situ? Make all staff aware of care needing to be taken

Continue assessment

YES NO 8 Will the patient need to get out of bed unsupervised? Consider alternative method

Continue assessment

YES NO 9 Is the patient alone at night?

Consider implications

Continue assessment

YES NO 10 Does the patient have a need for a pressure mattress or profiling bed? Ensure bed rails

are compatible & use high bed rails

Continue assessment

YES NO 11 Is the patient at increased risk of falling if bed rails are used? Consider

alternative method Continue assessment

Yes No 12 Does the patient refuse the use of bed rails? Consider alternative method

Continue assessment

If you have answered ‘Yes’ to any of the above and are still intending to prescribe bedrails, clear clinical reasoning MUST be documented


Affix Patient Label

Part A Outcome of the Assessment: Clinical Decision: What are the key factors for / against prescribing bed rails?

The reasons for / against using bed rails are:

These reasons have been explained to: (Please enter name of person)

The following are the benefits and risks of any alternative options and any particular concerns of this patient / carer / family:

Resultant action: Bed rails to be fitted / not to be fitted

Any comments:

Signature of assessor: Date:

Name of assessor (Print):

Job Title:

Site / Service: Review date:

If bedrails are clinically indicated from Part A then Part B MUST be completed




Appendix 2

Bed Rails Risk Assessment Part B Equipment / Fitting Checklist This tool should be used in conjunction with the Guidelines for the Use of Bed Rails and the clinician’s own professional and clinical judgement. Complete the information below NB: a patient label may be used as appropriate for the relevant information Choice of Bed Rails Name: DOB:

NHS no: GP: Date of Assessment: Assessor (Print):

Address:

Base/Unit: This is only to be completed by clinicians who have completed the NHS Northamptonshire Training specific to the issuing of bed rails and are deemed to be competent.

YES NO 1 Do you have enough information to select the bed rail appropriately? Continue Do not fit

YES NO 2 Is the bed rail suitable for the intended bed according to the supplier’s instructions? NB: Slatted or sprung bases are not suitable for divan bed rails.

Continue Do not fit

YES NO 3 Does the mattress allow the rail to be fitted to the bed securely so that there is no excessive movement? Continue Do not fit

YES NO 4

Does the benefit of any special or extra mattress out way any increased entrapment risk created by extra compression at the mattress edge?

Continue Do not fit

YES NO 5

Are the bed rails high enough to take into account any increased mattress thickness or additional overlay? Continue Do not fit

YES NO 6

Have you measured and are gaps between the bars / rails less than 120mm? Continue Do not fit

YES NO 7 Have you measured and are the head board and foot board to bed rail end gaps less than 60 mm or greater that 250mm? Continue Do not fit

YES NO 8 Would the provision of ‘Bumpers’ reduce the risk of entrapment and / or physical injury? Consider fitting

bumpers Consider alternative

YES NO 9 Will a bed bumper increase the risk of suffocation or entrapment due to movement or compression of bumper (covers are not air permeable)?

Consider alternative

Consider fitting bumpers

YES NO 10 Do you have enough information from the manufacturer / supplier on special considerations or contra-indications relating to choice of bed rail?

Continue Obtain further information


Affix Patient Label

Part B Equipment / Fitting Checklist Cont. YES NO 11 The decision to fit / not fit bed rails has been discussed with the

Patient / Relatives / Carers Continue Discuss with patient, relative, carer

Part B Outcome of the Assessment: Any outstanding issues that effect the situation?

Outcome of Assessment:

Patient / Relative / Carer in agreement with bed rails being fitted and willing to comply with

advice on usage and conditions of provision:

Signed:____________________________ Name:___________________________


Affix Patient Label

(Part B Outcome of the Assessment cont.) Prescription of equipment: Signature of assessor: Date:

Name of assessor (Print): Job Title:

Site / Service: Review Date:




Appendix 3

General Guidance on the Use of Bed Rails Bed rails should NOT be used:

• For keeping agitated or confused patients in bed because it makes the situation more hazardous as the patient may attempt to climb over or around the obstruction

• As a barrier to independence • As a form of restraint • If the patient is at risk from climbing over them • Special consideration needs to be given for patients with certain conditions where they have

a greater risk e.g. dementia, cerebral palsy, impaired / restricted mobility, very small or very large heads, repetitive or involuntary movements, communication problems or confusion

Bed rails may be considered suitable - with patients who: • Are drowsy and may be at risk of rolling from the bed • Are being moved or transferred from one area to another on a bed or trolley • Have a bed rail at home and are fearful of being in bed without them

What to do if bed rails are thought to be necessary: • Complete Bed Rails Risk Assessment Check List (Appendix 2) which includes evidence of

the decision making process • Ensure the bed rails to be used are compatible with the bed according to the manufacturers

instructions • Ensure the bed rails are maintained according to the manufacturers instructions • If a patient is injured or falls out of bed when bed rails are being used the need for bed rails

must be reassessed • If bed rails are in use but concerns still remain consider other alternatives to bed rails • Ensure that all parts of the patient’s body are clear from contact with the bed rails before

moving the bed rail • Avoid using a mattress overlay on top of an existing mattress where the additional height

lessons the effectiveness of the bed rail and may allow the occupant to roll over the top. Extra height bedrails should be used if mattress overlays are to be used

Special Considerations:

• If a request is made for bed rails to be used by a patient or relative but on risk assessment this is deemed inappropriate, the patient/carer must be advised as to the reasons why they are not being used and this explanation documented

• Patients who are particularly agitated may need to be nursed on a mattress on the floor to prevent injury; it may be necessary to use more than one mattress. This decision should be taken only after a full assessment of the situation and following discussion with the relatives

• There are some electrically operated beds that can be lowered to approximately 150mm from the floor. The major advantage is that the bed can be electrically operated and adjusted to a height that reduces the risk to staff caused by nursing at such a low height

• If there are still outstanding risks related to the issue or non-issue of bed rails an Incident form must be completed

• Bumpers can move or compress which may introduce entrapment issues. Some bumper covers are not air-permeable and may present a suffocation risk



Appendix 4

Information for Patients, Relatives and Carers Regarding the safe use of Bed Rails issued by NHS Northamptonshire

(Provider Services) We aim to assist patients to maintain their independence as much as possible. This may involve a number of risks, one of these being that patients may fall out of bed. Anxiety about falling out of bed is felt by many; however the number of reported injuries caused by falls out of bed is relatively small. It should be born in mind that bed rails would not prevent restless, agitated or confused patients from trying to climb over or around the bed rails, which may result in causing alternative or greater injury. There is also the danger of confused patients getting trapped between bed rails. Please be advised that bed rails cannot be used as a form of restraint as it is unlawful to restrain someone without their consent or on the instruction of a third party. If a patient is very agitated, it may be considered, with their own safety in mind, to nurse them on a mattress on the floor. If this is the case full discussion between all relevant parties will take place. The need for bed rails will be reviewed regularly. This may result in them no longer being needed or perhaps no longer safe to use and as a result they will be removed. Users of bed rails in the Community are responsible for reporting any changes that may affect the safe use of the Bed Rails supplied to them by NHS Northamptonshire (Provider Services). These may range from a change in a user’s or carer’s condition to issues with the function of the bed rails and also their positioning. These changes must be reported as soon as possible to any clinical member of NHS Northamptonshire’s staff who is involved with the patient’s care. If you have any questions or concerns, please do not hesitate to speak to a member of NHS Northamptonshire’s staff.

Appendix 5

Policy Impact Assessment – Screening Tool Name of Directorate: Provider Services

Date of Assessment: 23 February 2009

Policy being assessed Clinical Protocol for the use of Bed Rails within NHS Northamptonshire (Provider Services) Setting

Assessment Carried out by: Judith Glashen

Policy Title Who is affected

Statutory requirements

Full Assessment Needed Yes / No

Priority High / Medium / Low

Clinical Protocol for the use of Bed Rails within NHS Northamptonshire Setting

All NHS Northamptonshire clinical staff and patients

National Patient Safety Agency NPSA Department of Health - Medicines and Healthcare products Regulatory Agency MHRA

No

Medium




Policy Impact Assessment – Full Assessment Tool Name of Directorate: Provider Services

Date of Assessment: 23 /02/2009

Policy being assessed: Clinical Protocol for the use of Bed Rails within NHS Northamptonshire (Provider Services) Setting

Assessment Carried out by: Judith Glashen

1. What consultation process will be undertaken?

2. Where will records of this consultation be

kept?

Senior Clinicians and Managers within Provider Services, Provider Services

1. What existing monitoring arrangements are in place?

2. Are these sufficient? 3. Are any additional arrangements required

Incident reporting, complaints No Audit of the use of Bed Rails within NHS Northamptonshire through the Clinical Governance and Effectiveness Group1

1. How will the results of the assessment be published?

Through the minutes of Provider Services Clinical Governance and Effectiveness Group which is held 2 monthly

1 Terms of Reference under review at March 2009 likely to restructured as the Clinical Governance Committee


Policy aims and outcomes

Evidence for assessment

Difference in Outcomes

Assessing Impact Proposed action

To ensure safe and consistent practice in the Prescription and use of Bed Rails To ensure the protection of patients by following NPSA and MHRA Guidance

Incidents Audit of Clinical and Patient Experience Outcomes

Ensure that all Prescriptions are prescribed appropriately within and covered by NPSA and MHRA Guidance

Number of incidents around use of Bed Rails

Ensure that all staff have read the Protocol and are adhering to it Lead by the Community Logistics Service: To audit Community and Inpatient Bed Rail Prescriptions within high intensity / high usage Service Areas Informally @ 6 months post Protocol Implementation Formally @ 12 months post Protocol Implementation


Documents

Clinical Protocol for the use of Bed Rails within NHS ... · Clinical Protocol for the use of Bed Rails within NHS Northamptonshire (Provider Services) Setting Protocol PROV 11 March