Devices & Restraints

[texasnurse46]

On Section P.4. What would I put, If I had a family member who had requested all siderails up, nurse wrote on admit that this is restrictive, I don't think the patient could have got up by himself at all, for any reason. Of course, No Dr order for side rails up x 4. Family member with patient at all times. How should this be coded?

Thanks,

Texasnurse 46

[Talino]

Only if the rail/s have the effect of preventing a patient from getting out of bed. Can the patient get out of bed on his own, regardless he does it safely or unsafely? If the patient lacks that ability, then the definition of restraint is not met.

The facility should avoid addressing an equipment as restrictive, unless it has the actual effect to the patient. Let the surveyor make that call. You, disprove.

Altho it can be state-specific, an MD order is only required when a device is applied for the purpose of restraining. When a family requests the use of a device, the facility should evaluate the appropriateness of it's use and explain it's implications. Have a policy in place and document family interaction.

This provides a good guidance whenever a family requests the use of siderails ... http://www.ec-online.net/Knowledge/Articles/siderails.html

A very good SR decision tree http://www.fallsinltc.ca/siderails_decision_tree%202.pdf

[nightmare, RN]

We have a daily care plan for each resident with bed rails.This is signed ,daily to say that the bedrails are for prevention of falls and not restraint.This satisfies our surveyors (for the moment!) They are very twitchy about restraint even when it is for the safety of the resident.We are not allowed to use straps on wheelchairs unless the wheelchair is moving.Once it stops then the strap must be released.Chairs up against beds and table up against chairs are also viewed as restraint.