Are side rails considered restraints?

  1. We are discussing the use of side rails and if they are considered restraints. What are your thoughts on 2 rails vs full or 4 rail sustem? Do your patient have to sign for refusal of siderails? What is going on out there with side rails?
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    About Sassy1

    Joined: Jan '05; Posts: 7

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  3. by   BCMAqueen
    Quote from Sassy1
    We are discussing the use of side rails and if they are considered restraints. What are your thoughts on 2 rails vs full or 4 rail sustem? Do your patient have to sign for refusal of siderails? What is going on out there with side rails?
    We must have an MD order for four side rails for pt's with seizure disorders, muscle spasms, etc. because it is considered a retraint at my workplace. 2 side rails we can utilize if documented they are for mobility and bed controls and call light. I hate to think of safety as a restraint, but we have now gone to fall pads at bedside and alot of bed alarms.
  4. by   RN4NICU
    Quote from Sassy1
    We are discussing the use of side rails and if they are considered restraints. What are your thoughts on 2 rails vs full or 4 rail sustem? Do your patient have to sign for refusal of siderails? What is going on out there with side rails?
    The Joint Commission (JCAHO) considers siderails to be a restraint. I've never heard of having patients sign for refusal (not a bad idea though), though things might have changed as I haven't worked with adults for a very long time. Typically, I have just seen it charted in the patient record that siderails were refused. If you want to be really picky about it - putting the bed against the wall (so the patient cant get out on that side) is also considered a restraint.

    BTW, patient safety measures are a different issue - most places have a protocol for SR up when patients are medicated, unconscious, etc.
  5. by   stbernardclub
    YUP.....they sure are.....
    Quote from Sassy1
    We are discussing the use of side rails and if they are considered restraints. What are your thoughts on 2 rails vs full or 4 rail sustem? Do your patient have to sign for refusal of siderails? What is going on out there with side rails?
  6. by   HappyNurse2005
    2 side rails isn't a restraint, pt can still sit up and get out of bed easily. 4 siderails is, if the pt tries to get out of bed over the siderails, they could fall and injure themselves. there was one place i remembered where if the pt's wanted all 4 up, they had to ask for it, and ask for it each night, it wouldn't be done until they asked.
  7. by   Finallyat40
    the use of our siderails is an active restraint and requires a physician order. It's been recommended that we use three, leaving one of the bottom ones down (preferably the one closest to the chair or bathroom)
  8. by   CHATSDALE
    side rails require a md order and must be documented as a restraint is use
  9. by   lapappey
    And yet do all nsg schools not fail you for not putting up siderails?

    Sheesh.

    I work in the PACU, where this is a non-issue (and where I shudder to think what would happen if we did not use side-rails ...)
  10. by   medpsychRN
    Quote from BCMAqueen
    We must have an MD order for four side rails for pt's with seizure disorders, muscle spasms, etc. because it is considered a retraint at my workplace. 2 side rails we can utilize if documented they are for mobility and bed controls and call light. I hate to think of safety as a restraint, but we have now gone to fall pads at bedside and alot of bed alarms.
    We have one rail up and the bed against the wall. Didn't know this was considered a restraint (although I wondered about this). Have used bed alarms with varying rates of success. Still have had people fall. I have never heard of fall pads. Who makes them?
  11. by   PamUK
    YEs, I think side rails are a form of restraint but unless patients are monitered carefully (& lets be honest, the reason we put them up is so that we dont have to monitor them as carefully), they can climb over them & end up on the floor

    Which is what happened at my hospital - following an audit on patient falls, we discovered that many patients who had fallen had side rails and had climbed over them & ended up on the floor.

    So what we do now is assess the patient. If they are cooperative, we will assign a nurse aid to watch over them more carefully. If they are incoherent/fitting/uncooperative, we nurse them on a mattress on the floor. We explain the reasons to the family (many are shocked at first) but understand the theory behind it. Works for us anyway
  12. by   ?burntout
    All 4 side rails up in our hospital is considered a restraint unless the person is completely immobile. We have to have all 4 rails up with our specialty mattresses for safety-that is not a restraint.

    We have a lot of family members that raise all 4 rails up and we explain to them that it is considered a restraint, but we document this in our nurses notes if family raises all 4 rails and we do not.
  13. by   katy_kenemy
    [QUOTE=Sassy1]We are discussing the use of side rails and if they are considered restraints. What are your thoughts on 2 rails vs full or 4 rail sustem? Do your patient have to sign for refusal of siderails? What is going on out there with side rails?[/QUOTI am not sure if they are considered restraints, I have heard that if the pt verbally consents to 4 siderails (or 3) then that is fine. I have heard that 3 or 4 siderails can be construed as admitting the pt was a known fall risk-- not sure--- just what I have heard.
  14. by   Antikigirl
    Siderails, for what I have been told and new guidelines are considered a restraint, be it two or four. When I was in RN school they warned me of this coming, and they were right (as a student if we left them down we were in trouble too..LOL!).

    In my facility, which is assisted living...not only must one get a MD order, oh get this...you have to have a service plan meeting with family or a medical representitive for the patient. A nurse must be present, administration member, and service plan person too. The meeting discusses all the other ways of helping the patient besides rails, and must implement them first for trials before siderails can be considered at all. This must be done every three months!!!! UHGGGGGG!!!!! Yeah, our Docs love having to sign these orders all the time..especially for assisted living!

    This is then submitted to the state for review and they will choose whether we have met the criteria for side rails or not. Even if a resident says they want them!!!!!! Now that rubs me the wrong way, if a resident says they wish them, shouldn't they be allowed to have them if it is not contraindicated (for instance someone that has a history of going over siderails?)???

    When anyone at my facililty gets a hospital bed, it must be with no rails till otherwise authorized.

    I don't mind looking at alternatives (which going one side against the wall is, but not considered a restraint that I had heard of...but don't doubt it at all...I will check into that) with a team, but every three months seems a bit overboard to me!

    Great...just another hurdle we have to jump over for patient safety!

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