Did You Know?
allnurses is the largest community for nurses on the web. We now have over 388,823 members! Join today to network with other nurses, laugh, share, and much more.
| No. 30 | 
Dec 18, 2008, 01:15 AM
 Re: Doing away with side rails?
In our facility side rails have to be ordered, and signed by the resident or POA. We had a very restless and relentless resident that would not stay in bed, even though he said he was tired. He has two mats ,one on each side of his bed. The P.M. nurse let him lay on the mat, with a pillow. She said its not considered a fall because he wasn't on the floor. The resident was happy, and the nursing staff could get some work done. I don't know what the DON would think of it, but she wasn't there. I thought it was genius. This may be off subject but do you ever wonder just how the people who make up the rules about restraints etc. figure we can do our work. I have ended up taking a resident everywhere with me all shift, just to keep them safe. One on ones are not planned for at my job we don't have the time. With all restrictions, it's hard to insure safety. What are some of the tricks nurses have come up with to insure safety but still get work done?
 | | Advertisement Sponsored Links | | | | No. 31 |
Dec 18, 2008, 02:46 PM
Re: Doing away with side rails?
Think of all the time we waste doing pages of reports r/t rolling out of bed from 2 inchs off the floor. Sometimes I think department of health changes rules for job security. They don't address the poor staffing issues because of the facility but they worry about that.
| | No. 32 |
Dec 26, 2008, 07:42 PM
Re: Doing away with side rails?
Most states do not have mandated staffing ratios. Until that happens, then the only way for a facility to be cited on staffing is for there to be some resident outcome related to it. An example could be that the Restorative Nursing is not done because the CNA's who do the restorative are pulled to the floor to cover for call in's, or that there are odors or a high increase in pressure sores, or grooming issues, that can be directly attributed to staffing. Most of these things though, have to be observed by the surveyors, and you as well as I know what happens when the state walks in, everybody and their grandmother are called in to work!
| | No. 33 |
Jun 19, 2009, 05:03 AM
Re: Doing away with side rails?
I would like to add that the floor mats caused one of our clients in LTC to fall as she was headed to the bath room tripped fell and broke her hip, busted her head ( required 9 stitches) and although it's been almost a year ago she is terrified to get up and go to the bathroom now
| | No. 34 |
Jun 19, 2009, 09:52 AM
Re: Doing away with side rails?
We do not consider a fall onto the mat from a low bed a "fall" unless they roll off the mat. But yes, if a resident does not have freedom of movement anything can be a restraint. I believe side rails were considered a restraint after several residents strangled themselves by getting caught between the side rail and mattress. It is quite a challenge to think of some way to keep them safe.
| | No. 35 |
Jun 22, 2009, 06:04 PM
Re: Doing away with side rails?
When I started working as a CNA at the facility I am employed by ( quite some time ago mind you ) basically a big portion of residents were physically restrained to " keep them safe".  When it was mandated to do away with these restraints visions of bodies all over the floors went rampant through out the facility. To our amazement the tidal wave of falling bodies didn't materialize; in fact episodes of depression,adverse behavior and injuries from resident's trying to escape the restraint were significantly decreased if not eliminated. The residents were more receptive to requests as well as care provided. 
A couple of years ago, new to the position of RCC / Asst. manager an edict went out for zero tolerance to the use of side rails secondary to the risk of serious injury or death if entrapped in the side rail. Old feelings surfaced once again - bodies on the floor as opposed to in bed - a care planners nightmare for sure.  Once again removing the side rails didn't create falling bodies chaos. Overtime one or two residents may fall out of bed usually without serious injury - if injured at all. That's when a low bed comes into play ( with mats on the floor) to keep residents safe. When providing care we just raise the bed to an optimal height ( the beds are electrically controlled ) and ensure the bed is in it's lowest position when we leave the room.  Take Care everyone!
| | No. 36 |
Jun 22, 2009, 06:27 PM
Re: Doing away with side rails? Originally Posted by geriNurse1  We do not consider a fall onto the mat from a low bed a "fall" unless they roll off the mat. But yes, if a resident does not have freedom of movement anything can be a restraint. I believe side rails were considered a restraint after several residents strangled themselves by getting caught between the side rail and mattress. It is quite a challenge to think of some way to keep them safe.
I think you better check the MDS definition of a fall. A change from one plane to another is a fall. It is considered a fall if you catch the person before they hit the floor because if you weren't there, they would have hit the deck.
| | No. 37 |
Jun 24, 2009, 07:41 PM
Re: Doing away with side rails?
The MDS definition on "falls" and " level plain" certainly presents a challenge to the mind - once in desparation we tried using another mattress next to the low bed to allow for more unrestricted space to roll without actually rolling out of bed - did it work? - not - It still created a non level plain due to the frame of the bed. As far as an earlier reply about mats and people getting up for the bathroom - if a resident does try to independantly transfer / ambulate it's best not to use the mats for the sole reason of the increased risk of injury - keep the bed low and enlist the use of a bed alarm - in the time it takes them to get up from the low bed - if they can at all - the alarm should have sounded at first attempt giving added time for staff to respond. The roll or fall would still be less severe then if the bed had been in a higher position and with out the mat - But of course that is my opinion and you can choose to accept it or reject it - just offering some advice to a truly challenging issue. Take Care !!!!
| | No. 38 |
Jul 17, 2009, 07:01 PM
Re: Doing away with side rails?
The facility I work in is currently on a "the resident has the right to fall" kick. State surveyors were very restraint-focused this year, so we are implementing a new fall-risk program.
The staff as a whole is VERY resistant to it. However, I am pleasantly surprised to find that it is actually working out OK. I have only had one my residents fall, but better that she fell off the bed (trying to get up) as opposed to off the bed from another 12 inches up, going over the siderail. LOL
The hardest part is getting used to seeing my residents in bed with both siderails down and stopping myself from running frantically into the room and pulling rails up!
| | No. 39 |
Sep 02, 2009, 12:37 AM
Updated
Sep 02, 2009 at 12:50 AM by HappyState
Re: Doing away with side rails? Originally Posted by debRN0417 Remember. it is only a restraint if it keeps the resident from doing something that they would normally do. If the person can get out of bed, and you put up rails and that stops them, then of course it is a restraint. It is much safer to put an alarm on them and mats in the floor with a low bed and let them go onto the mat than to put up the siderails and have them fall over the rails or become entraped...
Geri-chairs...if you put someone up in a geri-chair and recline it so that they cannot get out, then it is a restraint. If they wouldn't try to get out, then not a restraint. If you put a seatbelt on someone to keep them from standing up from a chair...restraint....if it is just to help posture because they do not try to stand up...not.
I don't mean to insult anyone's intelligence by my examples, but sometimes we forget what is a restraint. I have cited facilities for using geri chairs and siderails as restraints. It is OKAY to use a restraint if indicated AFTER you have tried other less restrictive means, but you must have consent, care plan, and documentation of attempts at restraint reduction, as well as documentation that you are releasing, and checking and all that stuff.
It is such a challenge sometimes, and it seems that every facility has the one houdini, or person that falls all the time and you get at a loss as to what to do with them. What you can do is make sure that you have interventions in place for safety and that you are documenting that those interventions are in place. After each incident, make sure that you document that the intervention were in place, and then what else you are trying to do...care plan! If the person were to fall and get injured, as long as you can show that you have tried everything and that you have documented everything, then you would be hard pressed to have any deficient practice there. If you have someone who removes their alarms, you need to make sure it is care planned that they do it and what you are trying to do to keep them from doing it....document, document, document and care plan, care plan, care plan....  Sorry, I don't get on too much as I travel and am busy but leave me a message if I can help!
Hi! I agree with your answer! I thought to myself, she knows what she's talking about...aha! You cited a facility? Must be you are a surveyor?
The parts of your answer that I most agree with and can't emphasize enough is know the definition of a restraint and learn to recognize when something is a restrain and when it is not. Assess, use less restrictive means, care plan and document! |
| 295 members
2,468 guests 2,763
| 46 | | | 1 | | | 13 | | | 2 | | | 10 | | | 17 | | | 11 | | | 16 | | | 16 | | | 42 | | | 14 | | | 21 | | | 23 | | | 20 | | | 24 | |
|
Nursing News