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Bed rails (also known as side rails, bed side rails, cot sides, and safety rails) are adjustable metal or rigid plastic bars that attach to the bed and are available in a variety of shapes and sizes from full, three-quarters, half, one-quarter, and one-eighth in length as well as one or two (split rails) for each side of the bed. Full length bed rails are available in two basic designs, trombone (telescoping) and concertina/folding..
Examples of the different length bed rails: (A) full; (B) split; (C) half.
Bed rails are used in all caring environments from acute facilities to nursing and residential accommodation and in private homes. In the UK full length rails are mostly used whereas, in the USA, the predominant type of rail is the split-side rail. Split-side rails have been widely used in the USA for the last 25 years but they are relatively new in the UK. This difference is related to the use of electric beds which have been widely used in the USA since the 1970s. More recently in the UK hydraulic beds are being replaced with electric profiling beds. 3 There are also differences in the culture of rail use. In the UK there has been an "opt in" culture with a recommendation in 1975 that bed rails should not be used routinely and their use should be continually reviewed. 4 In contrast, the USA has had an "opt out" culture resulting from a recommendation in 1957 that bed rails should be permanently fixed to every hospital bed and used unless written instructions were given by the physician, accompanied by a signed release from the patient. 5
Concerns were raised about the safety of bed rails in 1997 in the USA. 6, 7 In 1999 the Food and Drug Administration (FDA) set up a working group (Hospital Bed Safety Workgroup, HBSW) to look at risks associated with the use of bed rails. 8 They identified several functions for rails including a physical barrier to remind the patient of the perimeters of the bed and to provide additional security when the bed and patient are moved. Rails are also used by patients to adjust their position by providing a handhold to assist turning and getting out of the...