Bed rails up only during bedside care = restraint?

Specialties Geriatric

Published

I was reviewing for my CNA state exam and came across something that I meant to ask my instructor about, but completely forgot about until now.

OBRA

Bed rails prevent the person from getting out of bed. They are considered restraints by OBRA and CMS. Bed rails cannot be used unless they are needed to treat a person's medical symptoms. Some people feel safer with bed rails up. Others use them to change positions in bed. The person or legal representative must give consent for raised bed rails. The need for bed rails is carefully noted in the person's medical record and the care plan.

Safety

You raise the bed to give care. Follow these safety measures to prevent the person from falling:

  • For a person who uses bed rails - Always raise the far bed rail if you are working alone. Raise both bed rails if you need to leave the bedside for any reason.
  • For the person who does not use bed rails - Ask a co-worker to help you. The co-worker stands on the far side of the bed. This protects the person from falling.

My main question: Are bed rails considered restraints if only used to ensure the resident doesn't fall during bedside care and they are lowered before you leave the resident?

In the nursing home where I had clinicals, I never encountered a resident that had bed rails up, but all the beds were against one wall. If the beds were open on both sides, I doubt I could have found a spare CNA to stand on one side of a bed for bedside care without bed rails.

If someone can take the time to explain this whole "when is it a restraint" issue I seem to be having, or point me in the right direction, I'd be very appreciative.

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re: bed rails up only during bedside care = restraint?

bedrails are considered a restraint when used to keep the resident from getting out of bed. if a resident requires bedrails up while in bed it has to be care-planned ,doctor ordered and consent forms must be signed either by the resident or if the resident is unable to consent the family has to sign consent forms. bedrails can only be used for safety of the resident and it has to be documented that the resident is unsafe with out them up. also bedrails can be up if the resident requests it for any reason this also has to be documented that the resident asked they be up. they can also be careplanned for bed mobility if the resident needs them to assist with turning himself etc. the resident has the right to fall but we are not supposed to let them fall. its a fine line. when you are giving care technically you are supposed to put them down at least one side so you aren't working over the rail which is bad body mechanics. most residents if they are alert will okay the rails up while being cared for if you ask them but make sure you know your care-plans up or down? and even after all of this and you have a resident that wants his rail down and its ordered to be up you must either ask him to keep them up if he will especially if he is a danger to himself or offer an alternative such as assisting him to a chair etc. but make sure you stay with him if he has orders to be monitered for falls etc. the nurse in charge must be notified example: middle of the night resident is restless and is climbing out of bed well most cases the nurse can order the rails up but she has so many hours to make a short term care plan and call family and doctor to notify them of this action and she has to justify it .it all boils down to the careplan . the careplan is your guide to your resident. the careplan tells you every thing you need to know about your resident and if you see a change of condition such as not being able to transfer safely whereas this resident was able to do last month then you report to your nurse in charge so a new careplan can be written. hope i helped. i have been an aide for 32 years. seen nursing home before obra title 22 and believe me i am glad for this law.

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Specializes in Day Surgery, Agency, Cath Lab, LTC/Psych.

My understanding is that bedrails are not a restraint if you are in the room providing patient care. An example of this would be if you needed to move the patient in their bed and had all 4 side rails up and were standing at the bedside. However, 4 side rails up is considered a restraint no matter what the purpose is of having them up. (As a side note, I think that 4 side rails up is an extremely unsafe restraint in the first place. Just imagine a confused old person climbing OVER the side rails to get out of bed. Not a pretty picture).

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I would never, never use all four bed rails unless it was ordered.

I was thinking about just the two upper bed rails. (The upper bed rail up on the side opposite me when I'm working. Both upper bed rails up when raising/lowering the bed or if I have to step away from the bedside while still in the room. Then I would lower the bed rails according to the care plan before I leave the room. Isn't that the way it is done for most residents?)

I'm just really confused. :uhoh3: From reading the textbook, it sounds like if the person doesn't have an order for bed rails, I must hunt someone down to stand on one side of the bed while I stand on the other and do what needs to be done. As busy as most CNAs are in LTC (and probably in most areas), I don't see how that is possible. Especially for the tasks that can take 10-15 minutes, like bed baths. There are barely enough aides on the floor as it is. It doesn't sound realistic to me. (Then, maybe I'm wrong. I'm so new to all of this!)

Is what I posted from my textbook (under Safety, second bullet) a preference or is it a requirement? I need to find this out before my state test next week and certainly before I start working.

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Specializes in nursing home care.

Bed rails are a hot issue over in the UK just now. All bed rail use must be care planned and family sign authorisation. In UK many homes are changing to beds with built in bed rails too as opposed to the kind you can just attach to a bed which are advised to be unsafe. In one home I worked we had to do risk assessments for climbing over bed rails, entrapment in bed rails. The least bed rails the better seems to be the key. I think I would feel better even if my bed had rails, to have two people care for me in bed.

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Good question zooz. I know when I give bedbaths alone I put up all the side rails so that when I turn the pt their legs won't be falling off the bed. I do it to protect the pt. I don't care about my body mechanics because pt safety comes first.

I put the two lower rails down when I'm done with the pt.

I do agree that all 4 rails up is a hazard when you are not in the room. One aide put up 4 rails on a pt who was confused but could walk, unsteadily. The pt wedged herself between the two rails and I had to take a screwdriver to get the rails off. She was stuck!

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zooz, why not ask your instructor for clarification?

Good luck on your test. You will pass.

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Good question zooz. I know when I give bedbaths alone I put up all the side rails so that when I turn the pt their legs won't be falling off the bed. I do it to protect the pt. I don't care about my body mechanics because pt safety comes first.

I agree with you. Patient/resident safety always comes first.

And I completely forgot about the legs! I wonder, if the bed has four rails, if it's acceptable to put both the upper and lower rails up on the side opposite me, and have only the lower rail (if I'm working on the upper body) or the upper rail (if I'm working on the lower body) up on the side that I'm on.

I've looked up this topic (bed rails up during bedside care) on the FDA and the CMS websites and can't find anything.

I guess it would also depend on if you're working with someone who has uncontrolled body movements. In that case, I would definitely go grab someone to stand on the opposite side for the fear of the patient jerking around and wedging themselves in between the rails.

I do agree that all 4 rails up is a hazard when you are not in the room. One aide put up 4 rails on a pt who was confused but could walk, unsteadily. The pt wedged herself between the two rails and I had to take a screwdriver to get the rails off. She was stuck!
What a nightmare! That poor patient. :uhoh21:
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zooz, why not ask your instructor for clarification?

Good luck on your test. You will pass.

I would, but she's on vacation until sometime in September.

Thanks, bethin.

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after much searching i finally found someone (an rn, i think) on a cna site that mentions this topic:

[color=#6d61bd]repositioning a patient in bed[color=#6c4687]: tell the patient you are going to roll them before you do it. be sure the siderails are up for safety! (*if the patient doesn't have an order for siderails, be sure to put the siderails down before leaving)
however, she doesn't say where she got that information from or if it's just her opinion. :o

this is frustrating me to no end. :lol2:

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Be aware of your body and the resident's body when moving a resident:

1. Use good body mechanics.

2. Never turn a resident toward the side of the bed with the side rail down.

Raise the side rail, walk to the other side of the bed and assist the resident

to turn toward the raised side rail.

3. Never lean over a resident in bed to do any procedure. Discomfort and

injury to both the CNA and the resident can result. The linen and your

uniform can cross contaminate.

4. Be certain the resident is wearing shoes or slippers with rubber soles when

getting out of bed.

5. Have resident sit on the side of the bed with feet flat on the floor 10-15

seconds and check for dizziness before moving.

6. Never move a resident by grabbing him under the arm.

7. Place pillow against headboard when moving a resident up in bed.

8. Ask resident to help as much as possible.

9. Move resident on a count of "one, two, three".

e. Understand that side rails can be considered:

1. A safety aid and must be up if bed is elevated to working height.

2. A self-help device to assist the resident to move independently.

http://www.ohca.state.ok.us/provider/contracts/nurse_aide/pdflib/Nurseaidetrainingcurriculum.pdf

It's 125 pages and I found this on page 23 (I think). I hope this helps some.

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My understanding is that bedrails are not a restraint if you are in the room providing patient care. An example of this would be if you needed to move the patient in their bed and had all 4 side rails up and were standing at the bedside. However, 4 side rails up is considered a restraint no matter what the purpose is of having them up. (As a side note, I think that 4 side rails up is an extremely unsafe restraint in the first place. Just imagine a confused old person climbing OVER the side rails to get out of bed. Not a pretty picture).

I agree four rails up is not safe. It doesn't keep them in bed, it just gives them more stuff to get tangled up in on the way to the floor. I have removed many an elderly pts leg ,foot, shoulder, etc from the rails. :angryfire The only time it works is if they have a sitter, then it gives the sitter time to get to them before they fall.

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