The prevention of patient falls in healthcare settings, with particular emphasis on the effect of bedrail use on falls and injury as part of multi-faceted interventions

PhD ThesisThis doctoral statement links previously published original research and places this in the context of the wider literature. Analysis of a national database identified over 200,000 patient falls, including 1,000 fractures, reported from hospitals in England and Wales during 2005/06, leading to excess morbidity, mortality, healthcare costs, litigation, distress and anxiety. Mean falls rates for acute hospitals were 4.8 falls per 1,000 occupied bed days, falls were most likely to be reported as occurring between 10:00 and 12:00, and in relation to bed occupancy, patients aged over 85 years and males were at greatest risk. Although the only such study on a national scale, its findings were congruent with earlier smaller studies. A cluster randomised trial of multifactorial interventions carried out in acute and rehabilitation wards for older people identified a significant reduction in rate of falls between intervention and control groups (incident rate ratio 0.59 95% CI 0.49-0.70). The use of a ward-based multidisciplinary approach and several components of the intervention were found in review of other successful trials of hospital falls prevention. A systematic review identified that both routine bedrail use and unselective bedrail elimination appear to increase the risk of falls and injury, and that direct injury from bedrails, including fatal entrapment, is primarily related to outdated equipment design, and poor fitting and maintenance. The dominant orthodoxy in the literature that bedrails are harmful and unacceptable appears to have become detached from the empirical evidence and patients’ views. A multi-hospital overnight survey of bedrail use found 25.7% of patients had full bedrails raised, with immobility the most significant factor associated with bedrail use on logistic regression (OR 62.5 95% CI 27.4-142.8). These findings were disseminated through publications for the National Patient Safety Agency and through additional journal publications, and influenced policy in UK hospitals and internationally