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.
I have heard something similar that is supposed to take place in our state come January 1st.
Even with "padding" on the floor, elderly clients who have osteoperosis will still break bones with the fall, no matter how much padding is placed there.
If they can break bones from pathological fractures..then why would the padding help?
It's one of those things that may take place, and then someone will wake up and realize that they didn't quite think it through.
We use side rails, half rails, 1/4 rails. It is done if that is the resident's preference. We fill out a form that clearly states that the resident would like the rails. We also write that it is not used for restraining the resident, but for bed controls, to help with movement and positioning in bed. If the resident does not want side rails, then we do not use them.
We have been doing intensive teaching with residents and use of call light to ask for assistance. It seems to be working pretty well. Of course we will use low beds and lipped mattresses if needed provided it is what would be needed to protect the resident. Always have to be careful with the restraint issue. Even a lipped mattress can be considered one.
There seems to be many interpretations and varied ideas about what is a restraint. This tells me that we are subject to our employers rules and regs. Our company had a hefty lawsuit with a side rail incident, hence the knee jerk change of rules. I feel like non medical personal make these decisions without in the "trenches" feedback. For now we must conform, but how to fight for what is in best interest of patients is challenging.
Specializes in Gerontology, Med surg, Home Health.
One of the most important aspects of using ANY restraint is the documentation. Restraints are permitted if you document everything else you've tried and the reason you need a restraint. And not everything is a restraint. We had one woman...every year the surveyors would pick her chart. She was relatively young AND retarded AND confined to a wheelchair. We had a zealot of a surveyor one year. She saw the woman sitting in her wheelchair with a tray in front of her. She went to the chart and didn't see any restraint documentation. She wanted to cite us. I said to her "the woman is non-ambulatory...couldn't get out of the chair if she wanted. It's all documented. AND she uses the tray only for bead making." Apparently the surveyor didn't believe me so off she goes to ask the resident. The resident looked at her and said "Are you blind? I can't get out of the damn chair anyway...do you want to take off the tray and see if I can walk? And where else could I do my bead work!!" We didn't get cited. It's all in the documentation...and in this case...ATTITUDE!
One of the most important aspects of using ANY restraint is the documentation. Restraints are permitted if you document everything else you've tried and the reason you need a restraint. And not everything is a restraint. We had one woman...every year the surveyors would pick her chart. She was relatively young AND retarded AND confined to a wheelchair. We had a zealot of a surveyor one year. She saw the woman sitting in her wheelchair with a tray in front of her. She went to the chart and didn't see any restraint documentation. She wanted to cite us. I said to her "the woman is non-ambulatory...couldn't get out of the chair if she wanted. It's all documented. AND she uses the tray only for bead making." Apparently the surveyor didn't believe me so off she goes to ask the resident. The resident looked at her and said "Are you blind? I can't get out of the damn chair anyway...do you want to take off the tray and see if I can walk? And where else could I do my bead work!!" We didn't get cited. It's all in the documentation...and in this case...ATTITUDE!
on the documentation thing- and continue documenting it- we have to write in the pts chart once a week and renew the dr.'s order for restraints every 48 hours.
Re the young woman- If this is a repeated problem just have her sign a request for her lap tray to enable her to participate in activities such as beading (cards, cooking, drawing etc) .
I love how every one knows better than us how to do our jobs!!
In our facility side rails have to be ordered, and signed by the resident or POA. We had a very restless and relentless resident that would not stay in bed, even though he said he was tired. He has two mats ,one on each side of his bed. The P.M. nurse let him lay on the mat, with a pillow. She said its not considered a fall because he wasn't on the floor. The resident was happy, and the nursing staff could get some work done. I don't know what the DON would think of it, but she wasn't there. I thought it was genius. This may be off subject but do you ever wonder just how the people who make up the rules about restraints etc. figure we can do our work. I have ended up taking a resident everywhere with me all shift, just to keep them safe. One on ones are not planned for at my job we don't have the time. With all restrictions, it's hard to insure safety. What are some of the tricks nurses have come up with to insure safety but still get work done?
Think of all the time we waste doing pages of reports r/t rolling out of bed from 2 inchs off the floor. Sometimes I think department of health changes rules for job security. They don't address the poor staffing issues because of the facility but they worry about that.
Specializes in LTC, ER, ICU, Psych, Med-surg...etc....
Most states do not have mandated staffing ratios. Until that happens, then the only way for a facility to be cited on staffing is for there to be some resident outcome related to it. An example could be that the Restorative Nursing is not done because the CNA's who do the restorative are pulled to the floor to cover for call in's, or that there are odors or a high increase in pressure sores, or grooming issues, that can be directly attributed to staffing. Most of these things though, have to be observed by the surveyors, and you as well as I know what happens when the state walks in, everybody and their grandmother are called in to work!
I would like to add that the floor mats caused one of our clients in LTC to fall as she was headed to the bath room tripped fell and broke her hip, busted her head ( required 9 stitches) and although it's been almost a year ago she is terrified to get up and go to the bathroom now
We do not consider a fall onto the mat from a low bed a "fall" unless they roll off the mat. But yes, if a resident does not have freedom of movement anything can be a restraint. I believe side rails were considered a restraint after several residents strangled themselves by getting caught between the side rail and mattress. It is quite a challenge to think of some way to keep them safe.
When I started working as a CNA at the facility I am employed by ( quite some time ago mind you ) basically a big portion of residents were physically restrained to " keep them safe". :uhoh21: When it was mandated to do away with these restraints visions of bodies all over the floors went rampant through out the facility. To our amazement the tidal wave of falling bodies didn't materialize; in fact episodes of depression,adverse behavior and injuries from resident's trying to escape the restraint were significantly decreased if not eliminated. The residents were more receptive to requests as well as care provided.
A couple of years ago, new to the position of RCC / Asst. manager an edict went out for zero tolerance to the use of side rails secondary to the risk of serious injury or death if entrapped in the side rail. Old feelings surfaced once again - bodies on the floor as opposed to in bed - a care planners nightmare for sure. Once again removing the side rails didn't create falling bodies chaos. Overtime one or two residents may fall out of bed usually without serious injury - if injured at all. That's when a low bed comes into play ( with mats on the floor) to keep residents safe. When providing care we just raise the bed to an optimal height ( the beds are electrically controlled ) and ensure the bed is in it's lowest position when we leave the room. Take Care everyone!
on the documentation thing- and continue documenting it- we have to write in the pts chart once a week and renew the dr.'s order for restraints every 48 hours. 
If this is a repeated problem just have her sign a request for her lap tray to enable her to participate in activities such as beading (cards, cooking, drawing etc) . 
Once again removing the side rails didn't create falling bodies chaos. Overtime one or two residents may fall out of bed usually without serious injury - if injured at all. That's when a low bed comes into play ( with mats on the floor) to keep residents safe. When providing care we just raise the bed to an optimal height ( the beds are electrically controlled ) and ensure the bed is in it's lowest position when we leave the room. 
Take Care everyone!
Havin' A Party!, ASN, RN
2,722 Posts
What is / isn't a restraint is fixed by definition for most of the facilities we work at.
Regulators and / or legislation set the parameters for what constitutes a restraint in pretty much all our settings.