Are side rails considered restraints?

BCMAqueen · Jan 20, 2005

We are discussing the use of side rails and if they are considered restraints. What are your thoughts on 2 rails vs full or 4 rail sustem? Do your patient have to sign for refusal of siderails? What is going on out there with side rails?

We must have an MD order for four side rails for pt's with seizure disorders, muscle spasms, etc. because it is considered a retraint at my workplace. 2 side rails we can utilize if documented they are for mobility and bed controls and call light. I hate to think of safety as a restraint, but we have now gone to fall pads at bedside and alot of bed alarms.

RN4NICU, LPN, LVN · Jan 20, 2005

We are discussing the use of side rails and if they are considered restraints. What are your thoughts on 2 rails vs full or 4 rail sustem? Do your patient have to sign for refusal of siderails? What is going on out there with side rails?

The Joint Commission (JCAHO) considers siderails to be a restraint. I've never heard of having patients sign for refusal (not a bad idea though), though things might have changed as I haven't worked with adults for a very long time. Typically, I have just seen it charted in the patient record that siderails were refused. If you want to be really picky about it - putting the bed against the wall (so the patient cant get out on that side) is also considered a restraint.

BTW, patient safety measures are a different issue - most places have a protocol for SR up when patients are medicated, unconscious, etc.

stbernardclub · Jan 20, 2005

YUP.....they sure are.....

We are discussing the use of side rails and if they are considered restraints. What are your thoughts on 2 rails vs full or 4 rail sustem? Do your patient have to sign for refusal of siderails? What is going on out there with side rails?

HappyNurse2005, RN · Jan 20, 2005

2 side rails isn't a restraint, pt can still sit up and get out of bed easily. 4 siderails is, if the pt tries to get out of bed over the siderails, they could fall and injure themselves. there was one place i remembered where if the pt's wanted all 4 up, they had to ask for it, and ask for it each night, it wouldn't be done until they asked.

Finallyat40 · Jan 20, 2005

the use of our siderails is an active restraint and requires a physician order. It's been recommended that we use three, leaving one of the bottom ones down (preferably the one closest to the chair or bathroom)

CHATSDALE · Jan 20, 2005

side rails require a md order and must be documented as a restraint is use

lapappey · Jan 20, 2005

And yet do all nsg schools not fail you for not putting up siderails?

Sheesh.

I work in the PACU, where this is a non-issue (and where I shudder to think what would happen if we did not use side-rails ...)

medpsychRN · Jan 20, 2005

We must have an MD order for four side rails for pt's with seizure disorders, muscle spasms, etc. because it is considered a retraint at my workplace. 2 side rails we can utilize if documented they are for mobility and bed controls and call light. I hate to think of safety as a restraint, but we have now gone to fall pads at bedside and alot of bed alarms.

We have one rail up and the bed against the wall. Didn't know this was considered a restraint (although I wondered about this). Have used bed alarms with varying rates of success. Still have had people fall. I have never heard of fall pads. Who makes them?

PamUK · Jan 20, 2005

YEs, I think side rails are a form of restraint but unless patients are monitered carefully (& lets be honest, the reason we put them up is so that we dont have to monitor them as carefully), they can climb over them & end up on the floor

Which is what happened at my hospital - following an audit on patient falls, we discovered that many patients who had fallen had side rails and had climbed over them & ended up on the floor.

So what we do now is assess the patient. If they are cooperative, we will assign a nurse aid to watch over them more carefully. If they are incoherent/fitting/uncooperative, we nurse them on a mattress on the floor. We explain the reasons to the family (many are shocked at first) but understand the theory behind it. Works for us anyway

Burnt Out, ASN, RN · Jan 20, 2005

All 4 side rails up in our hospital is considered a restraint unless the person is completely immobile. We have to have all 4 rails up with our specialty mattresses for safety-that is not a restraint.

We have a lot of family members that raise all 4 rails up and we explain to them that it is considered a restraint, but we document this in our nurses notes if family raises all 4 rails and we do not.

katy_kenemy · Jan 20, 2005

We are discussing the use of side rails and if they are considered restraints. What are your thoughts on 2 rails vs full or 4 rail sustem? Do your patient have to sign for refusal of siderails? What is going on out there with side rails?[/QUOTI am not sure if they are considered restraints, I have heard that if the pt verbally consents to 4 siderails (or 3) then that is fine. I have heard that 3 or 4 siderails can be construed as admitting the pt was a known fall risk-- not sure--- just what I have heard.