Are side rails considered restraints?

Antikigirl, ASN, RN · Jan 20, 2005

Siderails, for what I have been told and new guidelines are considered a restraint, be it two or four. When I was in RN school they warned me of this coming, and they were right (as a student if we left them down we were in trouble too..LOL!).

In my facility, which is assisted living...not only must one get a MD order, oh get this...you have to have a service plan meeting with family or a medical representitive for the patient. A nurse must be present, administration member, and service plan person too. The meeting discusses all the other ways of helping the patient besides rails, and must implement them first for trials before siderails can be considered at all. This must be done every three months!!!! UHGGGGGG!!!!! Yeah, our Docs love having to sign these orders all the time..especially for assisted living!

This is then submitted to the state for review and they will choose whether we have met the criteria for side rails or not. Even if a resident says they want them!!!!!! Now that rubs me the wrong way, if a resident says they wish them, shouldn't they be allowed to have them if it is not contraindicated (for instance someone that has a history of going over siderails?)???

When anyone at my facililty gets a hospital bed, it must be with no rails till otherwise authorized.

I don't mind looking at alternatives (which going one side against the wall is, but not considered a restraint that I had heard of...but don't doubt it at all...I will check into that) with a team, but every three months seems a bit overboard to me!

Great...just another hurdle we have to jump over for patient safety!

PBAJS · Jan 20, 2005

a cna's observation .... after our last inspection, i noticed -

- fall pads on the floor next to the beds were removed.

- a mattress that was on the floor was placed on a bed frame.

- the two beds against the wall were moved away from the wall.

fall pads may be great for the safety of the residents, however, i'm not sure about the usage and safety of the staff. when doing patient care, some coworkers would: a - stand the pads up on end; b - leave them on the floor and walk on the pads (did you ever try to walk on a mattress while carrying a pan of water? :rotfl: ); c - turn and slide them under the bed, and then when going around to the other side, forgetting the pad was there, would trip on the pad sticking out the other side :angryfire .

and on the subject of restraints: we have been told that the trays for the wheelchairs/gerichairs are a form of restraint and the trays should only be used at meal time.

[color=white].

anndoodle · Jan 20, 2005

In my state, siderails are considered a restraint unless the patient is able to let them down themselves. Basically, anything here is considered a restraint if the person is unable to "undo" it. For instance, a lap buddy in a wheelchair is not considered a restraint if the person in the wheelchair is able to remove it; a seat-belt device in a wheelchair is not a restraint if the patient is able to unbuckle it. But this must be witnessed by a nurse and well documented that the patient is able to undo which ever device is being used.

Sassy1 · Jan 21, 2005

Has anyone been pleased with the use of the fall pads? Have they been known to reduce injury with falls? Does anyone use them consistently? How are they cleaned?What is the criteria for having one order for a specific patient or does anyone that is deemed at risk for fall have one ordered?

Fun2, BSN, RN · Jan 21, 2005

Siderails a restraint? That is crazy. I don't think I've ever been in the hospital without the siderails up, unless I thought about putting them down myself. Who cares if a siderail is up? geeze

I guess next the IV tubing, and IV pole will be considered a restraint. :uhoh3:

toadie · Jan 21, 2005

i was taught in school and in practice that 4 siderails are considered a restraint. unless the pt requests them or they are needed for seizure protocol to hold pads, an MD must write an order. i've always been told three is okay. and i also know that an over the bed table is never a restraint. so, three side rails and a strategically placed over the bed table is never a restraint and requires no order, but is helpful if safety may be an issue. :rolleyes:

Sassy1 · Jan 21, 2005

Is there a difference between the policy for side rails in a Nursing Home as opposed to a Hospital setting?

scotswoman · Jan 21, 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?

I have just completed placements in two different hospitals only 15 miles apart. One of which does not give any consideration to the use of side rails and the other which asks for the patient's or relatives consent to use them. I think I actually agree with the latter. :uhoh21:

nursemike, ASN, RN · Jan 21, 2005

Siderails x4 was a restraint on our old beds, since they extended the length of the bed, but our new beds have rails that leave an open area at the foot, large enough for egress. The upper rails are pretty short, and the main rails extend to about the knee, which is longer than the old upper rails. The sales rep for the bed assured us that x4 was not a restraint on these beds, which is good, since all the controls are on the main, lower rails. We do sometimes leave one down for ambulatory patients, though.

As much as I sometimes think we go too far in trying to avoid restraints, I have to agree with our hospital's position that restraints do not prevent falls. Patients are wily and resourceful critters who'll find a way to fall no matter what you do, if you leave them unattended long enough.

I once saw a gentleman well into his 80's rip open the front of a Posey vest. I guess it wasn't a restraint for him, since he was able to undo it (I'm a 48 yr old ex-carpenter, and I couldn't do it, but I guess I wasn't as motivated.)

Had another pt who could Houdini out of a Posey anytime he wanted to. Found him after one such escape untying his unconscious roomate.