Safe use of bedrails - adult inpatient settings

This guidance applies to all staff within adult inpatient settings in NHS Ayrshire & Arran (NHSAA) who have responsibility for the provision, assessment, use, maintenance and fitting of bedrails. This includes staff working in acute, maternity, mental health, community hospital settings and community nursing. The aim of this guidance is to enhance patient safety in hospital settings by informing staff about the risks associated with integrated and removable bedrails, and outlining measures to reduce these risks.

Bedrails are used in healthcare environments to reduce the risk of patients falling out of bed and sustaining injuries. They are supplied as:

• Integrated - Incorporated into the bed design. These cannot be removed and remain with the bed.
• Removable – These may be attached and removed as required. However, they can lead to an increased number of adverse events, particularly where maintenance or pre-use checks are not undertaken.

Integrated bedrails are the preferred option, where possible, as they help reduce several risk factors highlighted throughout this guidance.

This guideline should be read in conjunction with the:

• Medicines and Healthcare products Regulatory Agency (MHRA) Device Bulletin 2021 Bed rails management and safe use
• NHS Ayrshire & Arran G108 Prevention and management of falls in adult inpatient settings.
• National Patient Safety Agency (NPSA), London, National Patient Safety Alert – NatPSA/2023/010/MHRA Published on 30 August 2023. Medical beds, trolleys, bed rails, bed grab handles and lateral turning devices: risk of death from entrapment or falls

MHRA NPSA Safety Action Notice (2023)

A Safety Action Notice was issued on 30 August 2023 due to the risk of death from entrapment or falls associated with medical beds, trolleys, bedrails, bed grab handles, and lateral turning devices. The notice outlined seven actions to be achieved, including:

1. Update your organisation's policies and procedures on procurement, provision, prescribing, servicing and maintenance of these devices in line with the MHRA's updated guidance on the management and safe use of bedrails.
2. Develop a plan for applicable staff to have training relevant to their role within the next 12 months including regular updates. All training should be recorded.
3. Review the medical device management system (inventory/database) for your organisation or third-party provider for devices within your organisation, including those which have been provided to a community setting (for example, the patient’s own home). Keep this system up to date.
4. Implement maintenance and servicing schedules for the devices in the inventory/database, in line with the manufacturer’s instructions for use and/or service manual. Prioritise devices which have not had regular maintenance and servicing. If this is outsourced, compliance with the schedule should be monitored.
5. Review patients who are children or adults with atypical anatomy as a priority. Ensure the equipment they have been provided with is compliant with BS EN 50637: 2017 unless there is a reason for using a non-compliant bed. Record this on the risk assessment and ensure measures are in place to reduce entrapment risks where possible.
6. Review patients who are currently provided with bedrails or bed grab handles to ensure there is an up-to-date documented risk assessment. Complete risk assessments for patients where this has not already been done and for each patient who is provided with bedrails or bed grab handles.
7. Implement processes to update risk assessments where the equipment or the patient’s clinical condition has changed (for example, reduction/improvement in weight or mobility) at regular intervals.

Patients receiving hospital care often have impaired mobility due to physical and/or mental health conditions. They may be less aware of their surroundings if they have cognitive or visual impairments, or if they are affected by anaesthetics, sedatives, analgesics or other medication. Their ability to remain safely in the centre of the bed may also be compromised by conditions such as stroke, paralysis, epilepsy, muscle spasms, or mental health disorders that impair judgment of risk (e.g. bipolar disorder or schizophrenia). These factors increase the risk of falling from bed.

Bedrails:

• Should only be used to reduce the risk of a patient accidentally slipping, sliding, falling, or rolling out of bed. When used for this purpose, bedrails are not considered a form of restraint and may not be suitable for every hospital patient.
• Will not prevent a patient leaving their bed and falling, and should not be used for this purpose.
• Can restrict patients who are independently mobile and may increase the risk of injury for those who are cognitively impaired, particularly if they attempt to climb over them.
• May pose a risk of entrapment or cause injury if a patient strikes the bedrail.
• Are not generally intended to be used as a moving and handling aid and should only assist patients in turning in bed if this is specified in the manufacturer's information guide.
• Should not be used by patients to hold onto when staff are providing personal care, such as during a bed bath
• Are not commonly used in mental health inpatient wards, as the risk can often outweigh the benefits.

Bedrails should not normally be used:

• If the patient is cognitively impaired or has a mental health condition that affects their capacity or judgement of risk, and they are at risk of climbing over the bedrail or exiting via the foot of the bed.
• If the patient is independently mobile, bedrails are not normally recommended. Where a patient who has capacity specifically requests bedrails, the risks and benefits should be discussed, and the rationale for the decision clearly documented in the patient's records.

Bedrails can be used:

• When a patient is being transported on their bed to reduce the risk of falls.
• In areas where patients are recovering from anaesthesia or sedation and remain under constant supervision.
• When a patient is assessed to be at risk of falling from bed without bedrails, and is not at risk of climbing over them.

In some circumstances, a patient may request the use of bedrails. Such requests should be considered on an individual basis and in light of the points outlined above. However, most decisions regarding bedrails require balancing competing risks.

The risks for individual patients can be complex and relate to:

• Their physical and mental health needs;
• The environment;
• Their treatment;
• Their personality;
• Their lifestyle.

Staff must use their professional judgement to weigh the risks and benefits of bedrail use for individual patients. All decisions regarding bedrail use must be clearly documented in the patient’s records and this decision should be made in consultation with:

• The Multidisciplinary Team (MDT)
• The Responsible Medical Officer (RMO)
• The patient and/or their carer(s)

Decisions about bedrails need to be made in the same way as decisions about other aspects of treatment and care as outlined in NHS Ayrshire & Arran’s Consent Policy for Health Professionals (G082). 

This means:

• If the patient has capacity to understand and weigh up the risks and benefits of bedrails, once these have been explained, the patient should decide whether or not bedrails are to be used.
• Within mental health settings, if a patient has capacity but requires bedrails, an MDT discussion should take place. The team should speak with the patient and their next of kin (NOK) to explain the risks and benefits and support informed decision-making if the patient is deemed at risk.
• This decision must be documented in the patient’s care plan and kept under continual review, provided the patient remains in agreement.
• If the patient lacks capacity, staff have a duty of care and must decide whether the use of bedrails is in the patient’s best interests.
• Staff should learn about the patient’s likes, dislikes and usual behaviour from the patient, relatives and carers as appropriate, and discuss these with them. Relatives or carer/s cannot make decisions for adult patients (except in certain circumstances where they hold Power of Attorney extending to healthcare decisions under the Adults with Incapacity Act 2000).

NHS Ayrshire & Arran provides a leaflet on the safe use of bedrails for patients, relatives, and carers. This leaflet includes information on bedrails and strategies for preventing falls. 

NHS Ayrshire and Arran does not require written consent for the use of bedrails. However, discussions and decisions arising from the assessment must be communicated to the patient and relevant others. The decision not to use bedrails must be documented with the same level of priority as the decision to use them.

Mental health inpatient wards

In mental health inpatient wards, the risks associated with bedrail use almost always outweigh the benefits. Patients with a range of mental health conditions—both organic and functional—may have impaired risk judgement, poor concentration, and difficulty following or retaining instructions. They may also present a risk of self-harm, including ligature hazards posed by bedrails or other potential ligature points. Therefore, any decision to use bedrails in this setting must be based on a multidisciplinary discussion, involving the patient where possible, or their next of kin (NOK) if the patient lacks capacity.

Any deterioration may be temporary. The use of bedrails may be required to reduce the risk of falls; however, this would also necessitate using a room with a hospital bed. These rooms are not anti-ligature and therefore must follow the Framework for Interventions.

Bedrails may be considered even if the patient does not require transfer assistance, such as a hoist, as they may be at risk of falls while in bed but not when mobilising.

Bedrail risk assessment: acute and community hospitals

Guidance for completion must be followed as outlined in the Bedrail Risk Assessment. The rationale for each decision should be clearly recorded, and a bedrail care plan initiated where indicated. Staff should consider the use of protective bedrail covers (bumpers) in accordance with individual patient assessments. As patients may transition rapidly between states of mobility and consciousness (e.g., from independence to semi-consciousness), assessments must reflect these changes.

All inpatients must have a Bedrail Risk Assessment completed on admission. The registered nurse responsible for the patient's care is accountable for ensuring a bedrail risk assessment is completed and reviewed. The risk assessment should be reviewed whenever the patient’s condition or preferences change, including:

• The patient has a fall, with or without harm.
• There is an acute change in the patient’s medical condition (e.g. new onset delirium, risk-taking behaviour, post-anaesthetic state, or significant change in weight or mobility)
• Patients should not routinely remain on a trolley beyond four hours where a suitable bed is available.
• If there are no changes to the patient’s condition or bedrail use, reassess weekly.

The behaviour of individual patients can never be fully predicted. NHSAA two-hourly Behaviour Monitoring Chart should be used in Acute and Community Hospitals to monitor risk-taking behaviours, identify patterns, and assist in determining the appropriate level of supervision required.

Bedrail matrix

To support clinical judgement, the Bedrail Matrix has been developed as a decision-making aid. Use the Matrix to guide your assessment of whether it is safe to use bedrails. This tool does not replace professional judgement—always consider the patient’s best interests and ask: Will having bedrails in place present a higher risk of harm to the patient?

Bedrail risk assessment: Mental Health Inpatient Services

Within mental health inpatient services, a bedrail assessment should only be completed when a patient is unable to mobilise independently and the multidisciplinary team (MDT) identifies a clear rationale for doing so, such as a deterioration in the patient’s physical condition. If the MDT concludes that the benefits of bedrail use outweigh the risks, the care plan must be updated accordingly. There is no requirement for a bedrail care plan on admission, as the default position in mental health inpatient settings is not to use bedrails except in exceptional circumstances.

The bedrail assessment should be completed immediately following the MDT meeting to ensure it accurately reflects the discussion. It should clearly outline the key points from the MDT discussion, including the risk-benefit analysis and the views of all attendees, including the patient, their next of kin (NOK), and the Responsible Medical Officer (RMO).

In mental health inpatient settings, the above guidance on assessment frequency applies to patients whose physical deterioration is due to an acute illness. It does not apply when the patient requires bedrails due to a chronic decline in physical condition with no expected improvement in mobility. For example, if a patient with advanced dementia is no longer mobile but remains at risk of falling out of bed, the bedrail assessment would not require updating provided the patient’s condition remains unchanged or continues to deteriorate. Bedrail use may also be considered in response to fluctuations or significant changes in a patient’s mental state. In such cases, ongoing review and discussion with the MDT is essential.

In all care settings, staff should use professional judgement to weigh the risks and benefits for each individual patient when completing the Bedrails Risk Assessment Tool. A key consideration is: if bedrails are not used, what is the likelihood that the patient may come to harm? To support this, consider the following questions:

• How likely is it that the patient will fall out of bed?
• How likely is it that the patient would be injured if they fell from the bed?
• How likely is it that the patient could climb over the bedrails?
• How likely is it that the patient could exit from the foot of the bed?
• Will the use of bedrails restrict the patient’s independent mobility?
• Could the patient become trapped or entangled in the bedrails?
• Will the patient feel anxious or distressed if bedrails are not in place?
• Could the use of bedrails cause emotional distress or confusion?
• Could the patient injure themselves on the bedrails?

When caring for patients in inpatient settings—consider the following:

• Does the patient demonstrate impaired judgement or reduced awareness of personal risk?
• Is the patient experiencing visual or auditory hallucinations which may result in unpredictable behaviour?
• Is the patient overactive, restless, or prone to sudden or impulsive movements?
• Is there a risk of self-harm to the patient or others, including potential ligature risks associated with bedrails?
• Is the patient able and willing to follow staff instructions, such as remaining in bed when bedrails are in use?
• Could the use of bedrails cause the patient anxiety or distress due to feelings of restriction or confinement?
• Can the patient be managed safely through enhanced observations or alternative interventions?

Atypical anatomy refers to a height of less than 146 cm, body mass of less than 40 kg, or BMI below 17. For smaller patients, there are increased risks when using standard adult beds and bedrails, as these may lead to entrapment and a higher likelihood of harm. There are two international standards for medical beds which include requirements for acceptable gaps in order to reduce entrapment risks.

• Adults - BS EN 60601-2-52:2010+A1:2015
• Children and adults with atypical anatomy - BS EN 50637:2017

Children and adults with atypical anatomy should be using beds or cots compliant with BS EN 50637:2017. If there is a clinical reason for using a non-compliant bed, this should be documented, including any interventions required to reduce risks. The majority of bedrails are designed to be used only with individuals over 1.46 m in height (4 feet 9 inches), which is the height of an average 12-year old child.

A risk assessment should always be carried out to determine the suitability of the bedrail for the individual child or adult with atypical anatomy, as bar spacing and other gaps may need to be reduced. When purchasing or assessing bedrails for children or adults with atypical anatomy, seek guidance from the manufacturer and ensure compatibility with the individual’s size and the specific circumstances of use.

A standard for medical beds intended for use with children was published in 2017. Footnote 4 advises that older beds may not comply with this standard and may have larger gaps, which are inappropriate for use with children and small adults. This should be considered as part of the risk assessment. It is recommended that the gaps between rail bars do not exceed 60 mm.

• A bedrail risk assessment must be completed for all inpatient adults, including those with atypical anatomy.
• A bedrail risk assessment must be completed for all inpatient children.
• If an adult or child has atypical anatomy, a suitable bed should be used.
• If an appropriate bed is not available, this must be documented, including the rationale and any mitigating factors, and escalated to the nurse in charge/site manager to identify alternative equipment and agree interim risk reduction measures.
• Contact Moving and Handling and/or the Falls Coordinator for advice if there are any concerns.

If it is established that a patient is at a significant risk of falling out of bed, alternatives to bedrails should be considered first. These include:

• Low-level beds/ Variable height beds at their lowest level
  • Reduce the risk of injury from a fall.
  • Suitable for patients at risk of climbing over rails with limited mobility.
• Crash mats (not used in acute wards)
  • Placed beside the bed to cushion falls.
  • Use with caution to avoid trip hazards for staff and patients.
• Bed positioning
  • Placing bed in the best area for increased observation.
  • Positioning a bed against the wall may reduce the risk of rolling out of bed, however the risk of entrapment between the bed frame and the wall needs to be carefully assessed.
  • Ensuring adequate space for safe access and egress.
• Higher level supervision
  • In line with G078 Higher Level Supervision (HLS) Guideline.
  • In line with Mental Health Services, Framework for Interventions Guideline.
• Bed exit sensor mats, passive infrared (PIR) sensors, guardian alarm (not used in acute wards)
  • Alert staff when a patient attempts to leave the bed.
  • May be used in conjunction with low beds or crash mats.
  • Hourly checks and appropriate room placement recommended.
• 2 hourly behaviour monitoring chart (acute and community hospitals)
  • To monitor risk taking, patterns of behaviour and as an aid to the level of supervision required.
• Bed grab handles (with caution)
  • Aid mobility but not designed to prevent falls.
  • Risk assess due to entrapment risks.
• Increased frequency of care and comfort rounds (acute and community hospitals)
  • Provides evidence that care needs have been addressed in line with individual need.
  • Evidences more frequent checks and may reduce risk-taking behaviour.
• Environmental adjustments
  • Improved lighting, clutter-free surroundings, and clear pathways.
  • Reduce distress and fall risk, especially for patients with a diagnosis of dementia.
• Multidisciplinary review
  • Involving Occupational Therapist, Physiotherapist, nursing, and medical staff to assess safer alternatives.
  • Ensures decisions are person-centred and in line with guidance.

Staff should consider the compatibility of the bed frame, type of bedrails, and mattress in relation to the individual needs and physical characteristics of the patient when completing the bedrail risk assessment.

Before using bedrails, staff must carry out the following visual safety checks:

• Inspect the bedrails for any signs of damage, faults, or cracks.
  • If any defects are found, do not use the bedrails. Clearly label them as faulty and arrange for immediate repair or replacement.
• Assess whether the patient’s body shape or medical condition increases the risk of entrapment.
  • Consider whether the patient’s head, neck, limbs, or torso could become trapped between the bedrails, mattress, or bed frame.
• If using detachable bedrails:
  • The gap between the top end of the bedrail and the head of the bed should be less than 6cm or more than 25cm to reduce the risk of head or limb entrapment in the upper zone.
  • The gap between the bottom end of the bedrail and the foot of the bed should be more than 25cm to reduce the risk of entrapment or climbing hazards at the foot of the bed.
  • The fittings should be in place, and the attached rail should feel secure when raised.
  • Staff should listen for an audible click or locking sound to confirm the bedrails are properly engaged.

Adjusting or profile beds

Most adjustable and profiling beds feature integral bedrails that are incorporated into the bed design or are offered as an optional accessory by the bed manufacturer. MHRA found they are involved in far fewer adverse incidents than the third-party type. However, they can involve some hazards so should be used with caution. Some beds have a single-piece bedrail along each side of the bed; these require care in use because when the bed profile is adjusted entrapment hazards can occur. These are not always obvious when the bed is in the horizontal position.

Split bedrails (one pair at the head end and one pair at the foot end) also require care in use because the space between the head and foot end rails may vary according to the bed profile adjustment. Therefore, on some designs, entrapment hazards may be created when the bed is adjusted to profiles other than flat. Use the rails as instructed by the bed manufacturer.

Bariatric beds

Bariatric beds allow the mattress base to be widened, however, when the bed is widened, the correct mattress for the bed size must be used. Using the incorrect mattress size could increase the risk of entrapment. The height of a bariatric bed from the floor can be higher than a standard bed, the risk of injury if a patient falls may be increased. Bariatric beds hired by the organisation have integrated bedrails that are load tested for patients to use to assist in repositioning.

Active, hybrid and mattress overlays

Active, dynamic or hybrid mattresses or mattress overlays may be prescribed in order to reduce the risk of pressure injury. These raise the resting level of the user relative to the top of the bed rail, the effective height of the rail will be reduced. In turn this may increase the risk of the bed user falling from the bed.

Highly compressible surfaces may also create additional entrapment hazards. The bed, mattress and rail system should be assessed in all configurations as these risks may not be obvious in a single arrangement. The risk assessment should consider the ‘worst case’ condition in particular: for example, the effective height of the top of the bedrail with the bed plus a fully inflated active mattress, or the highest point reached when an alternating cell mattress is used. Before and during use of specialist mattresses with bedrails, consider:

• The reduction in the effective height of the bedrail relative to the top of the mattress may allow the occupant to roll over the top of it; extra height bedrails may be required.
• The risk of entrapment in the vertical gap between the side of the mattress and the bedrail may be increased with an easily compressible overlay and/or mattress edge.
• If the standard mattress is replaced with an air mattress or lightweight foam mattress, third party bedrail assemblies (including the mattress and bed occupant) can tip off the bed when the bed occupant rolls against the bedrail. This is because many third-party bedrails rely on the weight of a standard mattress to hold the assembly in place. If the mattress is supplied with straps to secure to the bed frame, ensure these are in place and attached to movable parts of bed frame not non-movable parts.
• The risk of the bed occupant rolling against the bedrail may be increased with lateral turning devices, and this could lead to entrapment. Risk assessment is essential prior to application of these products.

For patients assessed as requiring bedrails but who are at risk of striking their limbs on the bedrails or experiencing limb entrapment between them, the use of bed bumpers should be considered.
In mental health services, bumpers are used alongside bedrails due to the increased risk associated with patients not remaining centrally positioned in the bed — for example, due to motor restlessness or impaired judgement of risk. Bumpers are also used to enhance comfort and safety and must be regularly checked to ensure they are in good condition, appropriately fitted, and free from any ligature risks. Further information can be found at Bed rails: management and safe use.

Patient safety can be enhanced by regularly checking that patients remain in a safe and comfortable position in bed and ensuring all items listed in the Care and Comfort Falls section are easily accessible.

It is essential that all individuals involved in the manufacture, supply, fitting, maintenance, and use of bedrails are aware of acceptable bed, bedrail, and mattress combinations, as well as any associated safety issues. Bedrails are included in the planned preventative maintenance scheme overseen by Infrastructure and Support Services, ensuring they are maintained in accordance with the manufacturer’s recommendations.

Bedrails are subject to wear and tear. The table below provides examples of visual cues and possible causes that may indicate a bedrail is defective and requires repair, reporting, or replacement. Staff should carry out a visual inspection to identify any defects and remove the bed or bedrail from use if it appears damaged or unsafe. The bed or bedrail should be replaced as appropriate.

Any defects or faults identified in a bed or bedrail should be reported in line with local Estates procedures (e.g., via FM First) to ensure timely assessment and repair. Where a defect is identified, staff should contact the Portering Team to arrange removal of the affected bed and the provision of a replacement.

Types of bedrails (integrated and non-integrated)	Area	Issues that may indicate a problem
		Bedrails not moving freely Any signs of rust on bedrails, joints and pins Any peeling or cracked paint on surfaces Any significant free play in joints or hinges Rails that are bent, twisted or distorted Damage to any plastic hinges, handles or components.
		Locking handles or clamps do not fully engage and hold the rails securely Rail stick when raising or lowering Welded joints have visible cracks.
		Latch buttons do not engage fully Release mechanism does not operate smoothly Rail does not lock into place easily.

Beds should be kept at the lowest possible height to reduce the risk of injury in the event of a fall, regardless of whether bedrails are used. Bed height should be considered and care planned on an individual basis. An exception applies to independently mobile patients, who are generally safest when the bed is adjusted so their feet rest flat on the floor while seated on the edge of the bed.

Beds should be lowered when direct care is being provided and raised once care is complete, where applicable. In the event of an adverse incident involving bedrails, staff must complete a Datix report and an Adverse Event Decision-Making SBAR if harm has occurred. For further guidance on what constitutes an adverse event, refer to the NHS Ayrshire & Arran Adverse Incident Policy and Supporting Procedures (only available on Athena intranet)

Bed rails, which fit under the mattress or clamp to the bed frame, should not be confused with bed grab handles (also known as bed sticks or bed levers), which are designed to aid mobility for people in bed and help them transfer to and from bed, rather than to prevent falls from bed.

Bed grab handles may present risks similar to bedrails, including entrapment. Their use should be subject to careful consideration, risk assessment, and documentation. Fatalities associated with entrapment involving bed grab handles have been reported.

Some bedrails can also be used as bed grab handles, as they have undergone testing to ensure they can support the additional loads associated with this use. However, not all bedrails are suitable for use as bed grab handles. If the risk assessment demonstrates that the bed occupant requires bedrails to prevent falls and bed grab handles to aid mobility, then appropriate bedrails that can support the occupant’s weight when used in this way should be selected. If a bedrail is not suitable for use as a bed grab handle, this could result in the bedrail breaking.

NHS Ayrshire & Arran aims to ensure bedrails are available for all patients assessed as requiring them.

When special mattresses are hired, the requisition form requires the make and model of the bed/bedrail to be stated. The company renting the mattress will be asked to confirm the mattress is compatible with the bed and bedrail in use. Refer to manufacturer`s instructions for advice relating to individual equipment.

Cleaning recommendations

Beds, bedrails, bumpers and mattresses must be cleaned after use; in accordance to The National Infection Prevention and Control Manual . NHS Ayrshire and Arran Infection Control Policy, guidance for the cleaning of contaminated equipment (e.g. blood spills) can be accessed here (only available on Athena intranet)

Maintenance

Bedrail repair is the responsibility of NHS Ayrshire & Arran Estates Department, when notified by staff as to the requirement. All bedrails should be asset identified (or are an integral part of beds which are asset identified).

New beds and integrated bedrails are maintained under warranty with the manufacturer, and all beds with integrated bedrails are part of a maintenance contract, facilitated by Estates. A visual check of bedrails prior to use is the responsibility of the nursing staff. Any bedrail found with defects, should not be used and reported to Estates for repair.

All guidelines and policies require review using the NHS Ayrshire and Arran Impact Assessment Toolkit by staff trained in this process.

Staff are reminded that they may have patients who require communication in a form other than English e.g. other languages or signing. Additionally, some patients may have difficulties with written material. At all times, communication and material should be in the patients preferred format. This may also apply to patients with learning difficulties.

In some circumstances there may be religious and/or cultural issues which may impact on this guideline e.g. choice of gender of healthcare professional. Consideration should be given to these issues when treating/examining patients.

Some patients may have a physical disability that makes it difficult for them to be treated/examined as set out in the guideline requiring adaptations to be made.

Patient’s sexuality may or may not be relevant to the implementation of this guideline however, non-sexuality specific language should be used when asking patients about their sexual history. Where sexuality may be relevant, tailored advice and information may be given.

This guideline has been impact assessed using the NHS Ayrshire and Arran Equality and Diversity Impact Assessment Tool Kit. No additional equality and diversity issues were identified.

1. Adults with Incapacity (Scotland) Act 2000 https://www.legislation.gov.uk/asp/2000/4/contents
2. Framework for Interventions Guideline http://athena/mentalhealth/gd/Clinical%20Guidelines%20%20Policies/MHS144.pdf
3. Medicines & Healthcare products Regulatory agency (MHRA), Bedrails: management and safe use Guidance on managing and using bedrails safely. Published 30 August 2023
4. National Patient Safety Agency (NPSA), Resources for reviewing or developing a bedrail policy, London, March 2007
5. National Patient Safety Agency (NPSA), London, National Patient Safety Alert – Medical beds, trolleys, bed rails, bed grab handles and lateral turning devices: risk of death from entrapment or falls. NatPSA/2023/010/MHRA Published on 30 August 2023
6. Nursing & Midwifery Council Guidelines for Records and Record Keeping, NMC, London. 2018.
7. Safe use of bedrails - https://www.hse.gov.uk/healthservices/bed-rails.htm
8. Bedrail risk management - http://www.hse.gov.uk/foi/internalops/sims/pub_serv/07-12-06/
9. BS EN 60601-2-52:2010+A1:2015 Medical electrical equipment Particular requirements for basic safety and essential performance of medical beds
10. The never events policy framework: An update to the never events policy

MHRA guidance on the safe use of bed rails