Doing away with side rails?

[mondkmondk]

One of our hospice patients tonight fell twice in 30 minutes. I asked another nurse why his bed didn't have side rails and he told me they were considered a form of restraint. When did all this happen?

We ended up putting him on 15 min. checks and since he wanted to sleep in his recliner tonight we put a seat alarm on him too. He takes many narcotics for pain and insomnia. I feel that as his cancer progresses and he takes more and more morphine, that he should have side rails for his safety.

What do you all think?

Blessings, Michelle

[mountain_biker_88]

I've seen several patients with the ability to go over siderails, so i don't believe they will stop him from getting out of bed. I don't disagree with their use, but they are not witout risk. There has been incidents where confused patients have gotten limbs and necks stuck in them. I think a pressure sensitive alarm would be more appropriate in this situation. I would also recommend putting a mat on the flow next to his bed. You can also get him a low bed as well.

[Virgo_RN, BSN, RN]

Yep, side rails are considered a form of restraint. I'm not sure when that came about, but as long as I've been in health care (since 2003), that has been the case.

I've also had a patient go over the side rail. She climbed right over and fell on the floor. This was in acute care. When I worked in LTC, we had low beds without side rails, but with thick pads on the floor next to the bed in case the person fell/climbed out.

[Virgo_RN, BSN, RN]

Just want to add that with A&O patients, we ask them if they want their side rails up. If the patient is confused, we can use them, but we must also use the bed alarm, frequent toileting, frequent visual checks, etc. If those efforts fail, then the person gets a sitter.

[purple_rose_3]

Side rails are only considered a restraint when all FOUR of them are up. As long as one of the rails are down, it's not a restraint.

[BookwormRN]

At our facility, we have to have the Pt sign a consent saying that it is ok for the top two side rails to be up while in bed.

I think even the two are considered a restraint...even if they are up so that the Pt can use the bed controls!

[KaroSnowQueen, RN]

:typing:twocents:I think it started sometime in the 90's. The state came into the LTCs one year and announced the residents had "THE RIGHT" to fall out of bed. That you didn't keep siderails on your bed at home, and this was their home, so therefore siderails were a restraint.

What a crock.

[CoffeeRTC, BSN, RN]

Side rails are only considered a restraint when all FOUR of them are up. As long as one of the rails are down, it's not a restraint.

Not true in LTC, maybe in acute setting.

Most facilities have done away with side rails all together. We just did this past year when we got all new beds (we were still using the crank beds...OMGoodness...I'm in love with the electric beds)

Now most of our beds have two little hand bars up on the tops...they are called enablers.

As far as falling out of bed....LOW beds are the answer. Depending on the mattress..they go all the way down to the floor. We use fall mats on both sides of the bed too.

Very rarely do we see an injury from a fall....now they are kinds rolls to the mats.

[Pinkster]

Side rails are only considered a restraint when all FOUR of them are up. As long as one of the rails are down, it's not a restraint.

This is what they are teaching us in Nursing school right now(we just went though our restraints unit a few weeks ago), and that yes the patient does have the right to fall.

[ktwlpn, LPN]

Not true in LTC, maybe in acute setting.

Most facilities have done away with side rails all together. We just did this past year when we got all new beds (we were still using the crank beds...OMGoodness...I'm in love with the electric beds)

Now most of our beds have two little hand bars up on the tops...they are called enablers.

As far as falling out of bed....LOW beds are the answer. Depending on the mattress..they go all the way down to the floor. We use fall mats on both sides of the bed too.

Very rarely do we see an injury from a fall....now they are kinds rolls to the mats.

Here in Pa even a half rail is considered a restraint-as is placing the bed against the wall...We have low beds and floor mats-and we will order 1 to 1 for frequent fallers. When a resident rolls from a low bed to the pads does your facility consider it a "fall"? We used to careplan that as a behavior-now it's considered a fall and we have to complete all of the appropriate paperwork....argh...

[wooh, BSN, RN]

The low beds are great for patient safety, but what about staff health? Bed changes are one thing, but incontinent patients, ugh! Not an ergonomic work environment at all! My back hurts just thinking back about my LTC days!

[purple_rose_3]

The low beds are great for patient safety, but what about staff health? Bed changes are one thing, but incontinent patients, ugh! Not an ergonomic work environment at all! My back hurts just thinking back about my LTC days!

Low beds have controls and you can raise it into the air.