Siderails in LTC

  1. In the facility where I work we have been slowly eliminating siderails. State guidelines say that siderails are a restraint, also there is a risk of being entangled in rails. So we are replacing SR's with different interventions. Some patients have very low to the floor beds, and we are also using bed alarms, concave mattresses, and posey rolls, also landing pads in case all other measures fail.
    If the facility that you work in is also doing this, what do you think of it? We had two people fall out of bed last weekend. The care plan for those two pts. was being followed, but it seems that the system that is suppose to protect them failed.
    •  
  2. 24 Comments

  3. by   canoehead
    Half side rails allow people to get up but also protect from falling out. But it seems to me that life was easier when we had the huge high beds that required a step stool and those noisy rattly rails. Patients were too afraid to get up from the high beds, and if they were nutty enough to try we would hear the rails crashing around from all the way down the hall. I always thought that rails were good as far as slowing people down and letting us get to them before they were actually up.

  4. by   panda_181
    I worked on a LTC facility as an NA for 2 1/2 years before becoming an RN, and I don't remember having that much of a problem with people trying to climb over the siderails. Those who would have tried to climb over, we just left them down. One siderail would be up (the side that they didn't leave the bed on) and the other side would be down. If they're going to try to get up, then let them. If they fall, it would still be less damage for them than falling over the siderail. There's no stopping some Alzheimer's patients, no matter what you do.

    Amanda
  5. by   renerian
    I am just starting at a SNF so I will be reading these posts to learn.

    renerian
  6. by   panda_181
    What is SNF? Is this a normal American abbreviation? I find I'm lost a lot in these posts from the abbreviations that I'm not used to...lol...

    Amanda
  7. by   Sleepyeyes
    Ok, we did these things, depending on the pt's level of awareness and condition:

    1. Low beds. (Unfortunately, the low beds did not raise for nurses or aides to do patient care, killing my back, especially when dealing with combative patients, and the heckuvit is there are NO rules in place for this for employers from OSHA, only "strong suggestions" --but that's another thread.) True, there were less falls, and we often put another Spanco (soft quilted) mattress alongside the bed for cushioning if the pt. rolled or crawled off.

    2. If no low bed was available, we'd push the regular bed next to one wall, and then put a mattress down on the floor next to it so if the pt. got out, they'd land on the mattress. In addition, the pt wore a loud alarm that was set off by a string that pulled out, attached both to their nightclothes and the bedframe.

    3. Leave the bed rail down and hook up a patient alarm to the bed and the patient's gown, so if they moved around as if to get up, the alarm would go off and alert staff. Usually those folks had to get up to potty a few times a night. A Bedside commode next to the bed was very reassuring to them. (Doesn't work for pts who take the gowns off before leaving the bed though)

    4. Get them outta bed. So they can't sleep. No problem; we all have those nights. We'll sit them in a chair near the nurse's station and walk them, feed them, amuse them, etc, til they're tired. If it happens a lot, could be a clue something's wrong.

    Sounds like all you guys need are the patient alarms, jones, so you know who's moving around and potentially getting outta bed.
    Last edit by Sleepyeyes on Oct 1, '02
  8. by   sunnygirl272
    Originally posted by panda_181
    What is SNF? Is this a normal American abbreviation? I find I'm lost a lot in these posts from the abbreviations that I'm not used to...lol...

    Amanda
    Skilled Nursing Facility
  9. by   adrienurse
    I often note that staff raise siderails while on autopilot, without thinking if the person really needs them. You don't know how many times I have come on at night only to find someone in a panic because they can't climb out of bed and go to the bathroom. I I hadn't found them, they'd probably either would have had to climb over the siderails (you know what that causes) or else be forced to soil themselves. I've also seen teeny little grandmothers get stuck between the two single side, siderails and could easily have strangled themselves -- not something we'd want to see happen. Though I'm afraid I cannot quote the study (I've lost it), there was a study done a while back that says that the person who falls while climbing over siderails is more likely to break a hip than those who have the rails down. This has to do with both the added hight as well as the body position they are in when they actually hit the ground.
  10. by   adrienurse
    SNF = Skilled nursing facility? As opposed to non-skilled nursing facility? Run by monkeys?
  11. by   shygirl
    We cannot put the beds against the wall, that is considered a restraint. we have siderails only if it's documented that patient has fallen out of bed or gets up unassisted. We use monitors that beep, low beds too
    Shygirl
  12. by   sunnygirl272
    Originally posted by adrienurse
    SNF = Skilled nursing facility? As opposed to non-skilled nursing facility? Run by monkeys?
    older term..as opposed to the equally outdated HRF, health related facility....which was originally intended for slightly higher functioning elders...skilled nursing implying that they had skilled.nursing.needs...

  13. by   nursedawn67
    Originally posted by jones58
    In the facility where I work we have been slowly eliminating siderails. State guidelines say that siderails are a restraint, also there is a risk of being entangled in rails. So we are replacing SR's with different interventions. Some patients have very low to the floor beds, and we are also using bed alarms, concave mattresses, and posey rolls, also landing pads in case all other measures fail.
    If the facility that you work in is also doing this, what do you think of it? We had two people fall out of bed last weekend. The care plan for those two pts. was being followed, but it seems that the system that is suppose to protect them failed.



    So far it is wroking ok, I still believe that a few res, need restraints though, because nothing else seems to work.
  14. by   Rustyhammer
    No longer can you restrain a resident for no apparent reason. LTC regs now state that you must use the least restrictive device and have all other alternatives tried documented. Low beds, "scoop" mattresses and half rails are all alternatives among others.
    Alarms can be considered a restraint if the resident is put back to bed and isn't allowed to get up.
    Other restraints = lap buddies (cusions across the w/c) tray tables,geri-chairs if it prohibits rising, seat belts and others.
    -Russell

close