Bedrail use in English and Welsh hospitals

To explore rates of bedrail use, nurses' rationale, and factors related to bedrail use.

An overnight observational study of patient and equipment characteristics related to bedrail use, analyzed using a logistic regression model.

A stratified random sample of seven organizations, drawn from 167 organizations providing acute general hospital care in England and Wales during 2006.

One thousand ninety-two inpatients on adult inpatient wards observed at night.

Categorical data on bedrail use related to bed type, mattress type, patient age, nurses' description of patients' mobility and confusion, and nurses' rationale for bedrail use or nonuse.

Approximately one-quarter of patients had full bedrails raised at night; prevention of falls was the nurses' main rationale. Full bedrail use was much more likely to occur in patients who nurses described as immobile and very or slightly confused. Older patients appeared no more likely to be given bedrails than younger patients after adjusting for individual patient and equipment factors.

Bedrail use varied significantly between organizations and could not be explained by differences in nurses' description of patients' mobility and confusion levels, equipment, or policy.