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Conclusion: The tool should be implemented in adult inpatient areas with an education programme about the risks of inappropriate bedrail use, followed by an audit.

Further research on its use in other clinical areas should be carried out.

Audit evidence suggests that nurses and other healthcare practitioners pull up bedrails when they are fitted to a bed without really considering whether or not they are needed (Govier and Kingdom, 2000).

Research evidence, however, indicates that instead of preventing injuries to patients, bedrails are actually responsible for causing injury and even death (Parker and Miles, 1997; Gray and Gaskell, 1990).

While this is perfectly acceptable, there may be inconsistencies and it raises the possibility of assessments not being evidence-based.

However, a consistent and evidence-based approach can be achieved by the use of a risk assessment tool suitable for use in any setting.

The nurse manager concerned sought help from her practice facilitator and a literature search was undertaken to find a suitable assessment tool.

However, it soon became evident that there were no bedrail risk assessment tools readily available for use, and those that were available were complicated and not suitable for everyday use on a busy ward.

In our trust, an incident on a rehabilitation ward, when an 80-year-old woman got her knee stuck in a metal bedrail, distressed the patient and the staff involved.Results: There was fair overall agreement between registered nurses and expert opinion, when choosing colours in the tool from five patient scenarios.When used on the wards, there was high agreement overall between professional judgements and novice CBRU users on bedrail use, and fair agreement between experienced and novice users.The MHRA (2006) suggested that most of the risks associated with the use of bedrails can be avoided if thorough risk assessments are carried out.Nevertheless, guidance as to what should be included in such an assessment tends to be broad and appears to be largely dependent on professional judgement and experience.

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