siderails

Hi, there. At my facility, we used siderails, until one of my colleagues attended a seminar and saw pictures of people trapped in siderails.
Apparently, more injuries(ie. falls) occur with the side rails up. And it is considered a restraint, so we've foregone them altogether, unless the resident wants them. Now we don't use any type of siderails at all and we don't have anything like bed alarms. We do have falls, still, but the care aides check more frequently on the riskier residents....

We can only use siderails if they are Rx'd. We use alot of body alarms and we have alarms that are mats that we lay next to the beds that will sound if they get stepped on. We use those for those that have a tendency to take the body alarms off. But we have alot more falls here than where I worked that used alot of siderails. But people do get hung up in them, and the ones that fall climbing over them always seem to get hurt worse.
Our facility always seems to be shortstaffed and I know that if we had a decent amount of staff, we wouldn't have all these falls. But, you all know how THAT goes...

For the most part, our facility is restraint free. We do use side rails but only the top two, to assist the residents in turning. We also have other "alerting" devices, such as Nurse Alerts, which are too easily removed by those clever enough. You wouldn't believe how many of them we have found in toilets, drawers and a variety of other places. We also use bed alarms but those are very touchy and seem to go off constantly. In wheel chairs we have chair pad alarms. I admit I get terribly frustrated at times because we used to have available to us a "Lap Buddy" which fits across the wheel chair and it looks like a thick pillow that slips under the arms of the chair. We are now denied the use of these which I believe is wrong. These are not really restraints as they can easily be removed and they simply serve as a reminder not to stand up alone. BUT, the facility wants to remain totally restraint free, so they stopped our use of them, stating the confused residents could not remove them upon command, therefore they are restrained. I like the idea of the floor pad with the alarm and I am going to ask our administrator to check into these. Do any of you have the Nurse alerts that hook into the call system??? At one time we had nearly 20 Nurse alerts on my unit. By the time you figure out who is ringing, the damage is done. I doubt there will ever be a perfect answer.

I find the floor pads of limited use, as by definition, if the patient is standing on the pad, he/she is already out of bed! You may just arrive in time to see them fall, but should not be tempted to rush in and catch them, possibly causing injury to yourself or the patient.

Some facilities remove the legs of the bed so that the mattress is a few inches from the floor.

I agree that bed rails can be dangerous. A few months ago, I was in the hospital. While I napped, someone came in and put all four bedrails up. I woke up and almost fell trying to climb over the rails to get out of bed.

WHAT??? NO SIDERAILS??? WHEN DID THIS ATROCITY HAPPEN???

I hate siderails!!! I've seen far too many pts get hurt because of them. I've seen two pts get caught between the bed frame and the rail, a few I've seen fall between the split rails (4 rails), one would climb over the rails and fall to the floor and even found one years ago dangling from the bed in a chest posey. I believe they do cause more harm than good. I've heard stories (one on c-span) where the pt's neck was caught when she fell thru the split rails, broke her neck and of course died. If they have cognitive impairment, they don't understand that the siderail is there for their safety and will try to climb over it or through it! The low-bed works for some, others are on the floor mats more than they are in bed. If a pt truely needs a restraint because no matter what the staff does to prevent injuries, the pt ends up injured anyway is either put the pt on 1:1 for fall percautions, or implement the enclosed bed. 1:1 depleats the staff ( which always seems to be depleated anyway). Facilities hate to use restraints because everyone wants a "restraint free" unit, but in my opinion, SOME PTS JUST NEED A RESTRAINT (ie) the enclosed bed.

We still use them. I like to put up three and leave one down. Usually the one I leave down is the one that is in the patients line of site to the bathroom.

I tend to do as PhantomRN. Three up and the one near the bathroom or the side of the bed the Pt gets out on down. If I really want four up, I put the over-the-bed stand the fouth side Instead of putting up the rail. The patient can push it out of the way, so it's not really restraining. Usually I have it so noise is made when they push the stand & then we have a better chance of knowing the Pt is getting up. Most often it is only two up on nonconfused patients or at Pt choice 0 - 1 up. YES they do cause serious accidents!!! Fx necks, arms, hips etc. We've had two deaths in my 12 yrs on this unit. Both fx necks!!! One was restrainted and the other was several hours later when she removed her neck immoblizer! This patient had a weak left arm, but reached over to the left with the right & not weighing much, pulled her self over the rail. I'm still shocked that she did it.
Denise