Bed rails protocol/algorithm?

CapeCodMermaid, RN · Jan 4, 2018

New CMS regs consider all bed rails to be restraints. We have a new side rail assessment and consent form. Why do they need the rails?

CoffeeRTC, BSN, RN · Jan 5, 2018

We haven't used side rails for at least 8 years. I honestly was surprised they are still used in LTC. A nearby facility just had a death due to entrapment.

CapeCodMermaid, RN · Jan 5, 2018

We've used quarter rails for years. You'd really have to set your mind to it to become entraped in them.

Kitiger, RN · Jan 6, 2018

When my Mom broke her ankle, she was in a nursing home for almost 4 months. She was a heavy lady, and very weak from Post Polio Syndrome. Once in bed, she could not change position without help. The nursing home didn't have bedrails on the beds, and Mom was terrified that the aides would not be able to catch her if she started to fall (when placing her on a bedpan, for example).

I brought in an electric bed for her, with bedrails. The nursing home people checked the bed over and gave the OK. Mom was SO relieved! Not only did she feel safe, she could pull on the rail to change her position slightly. When you can barely move, even a slight adjustment is a wonderful improvement!

Of course, the fact that it was electric meant she could sit up in bed without having to ask - and wait - for help. But she would have been afraid to do so without the bedrails.

Bedrails are not the best choice for everybody, but there are times when they are the only safe choice.

CapeCodMermaid, RN · Jan 6, 2018

I'm amazed you were allowed to bring in your own bed and I'm shocked that the facility was still using crank beds. I haven't seen a crank bed in use around here since the late 90's

Tenebrae, BSN, RN · Jan 6, 2018

We dont have a specific one for bed rails.

Bed rails are counted as a restraint and if its felt that the patient needs bed rails, we have to go through the restraint assessment form to be able to use the bed rails.

Kitiger, RN · Jan 8, 2018

I'm amazed you were allowed to bring in your own bed and I'm shocked that the facility was still using crank beds. I haven't seen a crank bed in use around here since the late 90's

I did get permission first, and you're right - it wasn't a given that it would be allowed.

Medicare would not pay for an electric bed in the nursing home, because if she needed the head of her bed raised, all she had to do was turn on her call light, and the ever-present aides would immediately come to help her. Not.

The aides were mostly good, but we all know that they are spread `way too thin!

mlolsonny · Jan 13, 2018

The first two questions with rails, grab bars, assist bars, etc. are restraint and safety. Looking at safety is much more broad than the aspect of acting as a restraint.

Here are the questions from a side rail assessment that we developed after a survey tag r/t safety.

Physical restraint: Any manual method or physical or mechanical device, material or equipment attached to or adjacent to the resident's body that the individual cannot remove easily which restricts freedom of movement or normal access to ones' body.

Does side rail use meet the definition of a restraint for this resident?

Yes/ No

STOP HERE-SIDE RAIL USE NOT INDICATED FOR THIS RESIDENT

Mark rails with Red tape or remove from bed.

Is resident immobile (comatose, paralyzed, no spontaneous movement)? *Yes/ No

If primarily immobile, does the resident have enough mobility to turn or slide to one side? *Yes/ No

Has resident ever sustained bruises, skin tears, lacerations or fractures from a side rail? *Yes/ No

Has resident ever become entangled in the side rail or entrapped between the mattress and the side rail? *Yes/ No

Is the resident able to turn from side to side independently with use of rail? Yes/ *No

Does side rail use increase resident's physical mobility? Yes/ *No

If any starred answers chosen, side rail use indicated only with presence of staff.

Mark rails with Yellow tape.

If mobile, does resident make any attempt to get out of bed? Yes/ No

If mobile, can resident get in/out of bed safely without any human assistance or assistive device? Yes/ *No

If mobile, is the resident at risk for orthostatic hypotension or does resident have difficulty with balance/trunk control? *Yes/ No

If mobile, does resident have decreased safety awareness due to confusion or judgment problems? *Yes/ No

If starred answers chosen, rails increase risk for falls. Document increased risk and informed consent from resident/ family member (include name of family member giving consent).

Does side rail use increase resident's risk for falls? Yes/ No

Is this resident safe to use rails when they wish? Yes/ No

If yes, mark rails with Green tape.

Is OT/PT evaluation needed for transferring and/or ambulation skills? Yes/ No

After completing assessment, please mark side rails with appropriate color tape:

Green= Go-may be up at any time the resident wishes.

Yellow= Use with caution- staff presence required for rail use.

Red= STOP-Do not use Side rail(s) for this resident.

Analysis of risk factors:

RN Assessor: Date:

vintagemother, BSN, CNA, LVN, RN · Jan 16, 2018

I'm amazed you were allowed to bring in your own bed and I'm shocked that the facility was still using crank beds. I haven't seen a crank bed in use around here since the late 90's

When I was an LV/PN, I worked at a few LTCs that still had crank beds through 2014.

JeanBean66 · Jan 16, 2018

We use a similar assessment on all residents and most of them use quarter rails to assist with turning and positioning, assisting with independence.

Some want it to feel safe while self positioning at night.

Daisy Joyce · Jan 18, 2018

I worked a shift thru agency that sent me to a facility that still had a couple of crank beds.

I was trying to raise the head of the bed on an A&O resident and she told me "the crank is at the foot of the bed."

Then she got a good laugh at my facial expression.

(That facility got a lot of agency coverage...)