The Hazards of Bed Rails

LivingWithTheBreeze · Mar 15, 2010, 12:43 PM

Originally Posted by Florence H.H.

OMG I can't believe in this era of supposed enlightenment this discussion is even being carried out. Bed rails present substantial risks and should only EVER be used with massive caution. This is evidence based - which is what we nurses should be basing their care on. In cases like ICU - the staff are there right beside the patient and can negate the harmful effects while using them to their most advantagious. aIn all other cases, nurses should be relying on their own research to back up any practice - never mind something as dangerous as this.

As a student, we are suppose to be taught the safest way to perform procedures r/t evidence based practice. Bed rails up is still being taught. I guess it just goes to show we are all in charge of our own education.

Florence H.H. · Mar 15, 2010, 01:47 PM

You bet girl.It's against best practice to use bed rails. Nurses mistakenly believe it'll help 'prevent' falls. It's up to each nurse to be happy with her practice as - in the event of any legal action - it's not hospital or unit policies that'll stand up against the prosecution brief's - it's best practice. Law of Tort and all that!.

Zeppsn · Mar 15, 2010, 06:33 PM

People who say that bed rails cause more harm than good are the same people who refuse to wear seat belts because of the rare chance that they might actually be in a car accident where the seat belt itself kills them. Bed rails are an intervention that, more often than not, saves people from injury.

melmarie23 · Mar 15, 2010, 06:43 PM

in the instances where the policy is rails down and mats on the floor-wouldn't the mats pose a hazard as well? One can trip/stumble over them no?

Ayvah · Mar 15, 2010, 11:57 PM

Originally Posted by melmarie23

in the instances where the policy is rails down and mats on the floor-wouldn't the mats pose a hazard as well? One can trip/stumble over them no?

Absolutely. I've had patient falls due to the mats themselves.

tewdles · Mar 16, 2010, 06:03 AM

No question, mats can be a tripping hazard...bottom line is this, confused and agitated adults will fall from time to time. We just have to try to minimize the frequency and the severity without tying them up...although I am quite sure there are those patients whom we would dearly love to tie up and put in a closet with duct tape over his/her mouth.

morte · Mar 16, 2010, 07:52 AM

Originally Posted by tewdles

No question, mats can be a tripping hazard...bottom line is this, confused and agitated adults will fall from time to time. We just have to try to minimize the frequency and the severity without tying them up...although I am quite sure there are those patients whom we would dearly love to tie up and put in a closet with duct tape over his/her mouth.

mattresses on the floor are even worse than mats....the high density mats with beveled edges arent too bad.
i like the alarmed mats, when the patient steps on them they alarm. this would apply more to the wanderer than the truly unsafe-to-ambulate....there are also alarms that apply to the edge of the mattress, so the patient can move about in the bed freely.....

*luvRNs* · Mar 16, 2010, 10:31 AM

Originally Posted by KAUAIRNEMT

Rails vs no rails. First of all we have to be more specific on where rails are hazards. For example, in ER, ward, pediatric, nursing homes, home care patients. For majority of patients under the care of a professional/nurse, I say rails up for many reasons.
One, it reduces falls of patients which is one of the priorities of care-safety. It noted in the article that rails increase the risk of injury because of the additional height/angle it will provide BUT without rails the "fall" will become "falls" which is worse. Ask yourself, do you need to wait until a patient fall bofore start using rails? I worked in ER before and rails are mandatory and the reasons are obvious-meds, AMS, etc. One fall can kill. There is no statistics about how many falls bed rails have prevented.
Second topic, injuries cause by rails. Neck getting stuck between the rails and bed. In this case, either the design of the bed or/and the evaluation of patient was lacking. More leaning of the evaluation of patient because a rail does not asphyxiate patient in purpose. Agitated patients should be the closest room from the nurses station for best monitoring/safety.
There are more advantages in bed rails than without.

I think you may need to be more specific as well. Is your response based on best practice, or personal experience? I think most of the research shows the opposite.

dcampbell · Mar 16, 2010, 11:43 AM

There is a high likelyhood that I will have shoulder surgery next month.
Can I BEG the PACU to PLEASE keep the siderails up for me?
I don't want to fall out of the bed.

PorterM · Mar 17, 2010, 11:01 AM

http://www.fda.gov/MedicalDevices/Pr.../ucm123676.htm

To restate, using bed rails to keep patients in bed is an intervention. Like any and all interventions we nurses perform it can do both harm and good. There can be almost no blanket covering policy that fits all situations. It is up to each of us to provide for the safety of each of our patients. In an icu with my monitors producing cvp, wedge, icp and such I cannot lower the bed to the floor. I need it level with equipment and high enough for the patient to be seen. Bed rails can be used here with very frequent (even for ICU standards) direct nurse monitoring.

If my patient is AxO with no hx of dementia or other neuro problems I will leave just the top 2 rails up so that they have something to hold on to when they turn or sit up.

I feel both provide for the safety and comfort of both patient and nurse. You may encounter the odd exception, as I myself did but, if you view them as the intervention they are you should be ok.