Throughout my nursing career, side rails were seen as a benign safety device. The standard used to be that side rails were automatically used for all patients.
However, side rails are not the safe medical device we all thought they were. Each year 40 patients die secondary to side rail use. How - patients become trapped with their face pressed against the matress, have their neck caught between the rails or are trapped between the side rails after sliding partially off the bed. In addition, another 225 injures can be attributed to side rail use. However, it is important to note that not all deaths/injuries from side rails have been reported.
NOTE: yes - side rails remain appropriate for some patients. However, they should never be automatically used without assessing the dangers associated with their use.
Uninformed people state that they use side rails to prevent being sued by a family if a resident falls out of bed. It is important for us to continue to educate ourselves about changes of practice. Research has shown that restrined persons are twice as likely to fall and three times more likely to sstain an serious injury from a fall then a unrestrained person. Side rails on a bed will cause greater injury if a resident climbs over them and falls to the ground. In addition, the possiblity of entrapment and suffocation from side rails exists.
HCFA's Side Rails Interim Policy (2/4/97) notes that all types of side rails (full raisl, half rails and split rails) may pose an increased safety risk.
The FDA issued a FDA Safety Alert: Entrapment Hazards with Hospital Bed Side Rails in 1995.
Articles - Deaths Caused by Bedrails - Journal of American Geriatrics Society 45:797-802, 1997
An Analysis of Falls in the Hospital: Can we do without Bedrails? Hanger, Ball, Wood. Volume 47,Number 5. May 1999. Jounal of American Geriatrics Society.
There are multiple (>50 articles) related to the risks of side rails - I had the most luck utilizing a search - medical devices side rails on beds.
HCFA's National Restraint Reduction Newsletter Summer 2000. http://www.hcfa.gov/p...sletters/res...2000rr0600.asp
Untie the Elderly - http://www.ute.kendal.org/archives/jul99news.htm
In our efforts to educate staff, families etc. about side rail dangers, we have made a binder of these articles.
PLEASE TAKE THE TIME TO EDUCATE YOURSELF ABOUT THIS TOPIC. THE DEATH CAUSED BY BEDRAILS HAS GRAPHIC ILLUSTRATIONS OF HOW PEOPLE HAVE BEEN KILLED BY SIDE RAILS. THINK BEFORE YOU AUTOMATICALLY PULL UP THE SIDE RAILS.
PLEASE LET ME KNOW IF THIS IS A HELPFULL ALERT FOR YOUR.
Jul 7, '01
In LTC settings side rails are a big no no. On admission, we have to automatically get an order for 2 siderails DOWN, then re-eval after 3 days. The theory is that we will only use them IF a need for them has arisen, and then they can only be used if the resident needs them for repositioning assistance. They must also be able to demonstrate this to a state inspector on request. A 3 day assessment of side rails is done on admission. If the family chooses to request rails for an incompetant resident, then it must be treated as a restraint with all the documentation, reduction attempts, etc. They also feel that in addition to being trapped in the rails, that if they are confused and try to climb OOB, they will go OVER the rails......in effect falling farther than if they were down. We have Ultra low beds, mats on the floors, alarms..all sorts of alternatives to side rails. Even if they need them to reposition and can demonstrate it, if they want full rails instead of half rails, they have to sign a "dual side rail request form".
My biggest task is getting the CNA's to comply with the MD orders!!! We use colored tape to indicate if the rails should be up or down......but I constanly have to go behind them and make them do it correctly....they LOVe to put the rails up...especially the aides from the "old school"!!LOL!
Last edit by 2LTCnurses on Jul 7, '01