1. I'm sure this is a topic that has been brought up before however, I was just curious how different facilities around the country are dealing with the changing regulations on siderail usage.
    Here in Washington we have had two deaths in the past year due to siderails and it has become a very hot topic for surveyors. Siderails are no longer viewed as a "restraint" issue. It is now a safety issue.
    What is the policy and procedure in your facility for siderails? What kind of beds or adaptive eqiptment are you using in lieu of siderails?
    Just curious. thanks in advance for your responses.
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    About Slowone

    Joined: Aug '01; Posts: 65
    agency nursing


  3. by   Paprikat
    Hi, there. At my facility, we used siderails, until one of my colleagues attended a seminar and saw pictures of people trapped in siderails.
    Apparently, more injuries(ie. falls) occur with the side rails up. And it is considered a restraint, so we've foregone them altogether, unless the resident wants them. Now we don't use any type of siderails at all and we don't have anything like bed alarms. We do have falls, still, but the care aides check more frequently on the riskier residents....
  4. by   rebel charm
    We can only use siderails if they are Rx'd. We use alot of body alarms and we have alarms that are mats that we lay next to the beds that will sound if they get stepped on. We use those for those that have a tendency to take the body alarms off. But we have alot more falls here than where I worked that used alot of siderails. But people do get hung up in them, and the ones that fall climbing over them always seem to get hurt worse.
    Our facility always seems to be shortstaffed and I know that if we had a decent amount of staff, we wouldn't have all these falls. But, you all know how THAT goes...
  5. by   duckie
    For the most part, our facility is restraint free. We do use side rails but only the top two, to assist the residents in turning. We also have other "alerting" devices, such as Nurse Alerts, which are too easily removed by those clever enough. You wouldn't believe how many of them we have found in toilets, drawers and a variety of other places. We also use bed alarms but those are very touchy and seem to go off constantly. In wheel chairs we have chair pad alarms. I admit I get terribly frustrated at times because we used to have available to us a "Lap Buddy" which fits across the wheel chair and it looks like a thick pillow that slips under the arms of the chair. We are now denied the use of these which I believe is wrong. These are not really restraints as they can easily be removed and they simply serve as a reminder not to stand up alone. BUT, the facility wants to remain totally restraint free, so they stopped our use of them, stating the confused residents could not remove them upon command, therefore they are restrained. I like the idea of the floor pad with the alarm and I am going to ask our administrator to check into these. Do any of you have the Nurse alerts that hook into the call system??? At one time we had nearly 20 Nurse alerts on my unit. By the time you figure out who is ringing, the damage is done. I doubt there will ever be a perfect answer.
  6. by   donmurray
    I find the floor pads of limited use, as by definition, if the patient is standing on the pad, he/she is already out of bed! You may just arrive in time to see them fall, but should not be tempted to rush in and catch them, possibly causing injury to yourself or the patient.
  7. by   135ctv
    Some facilities remove the legs of the bed so that the mattress is a few inches from the floor.

    I agree that bed rails can be dangerous. A few months ago, I was in the hospital. While I napped, someone came in and put all four bedrails up. I woke up and almost fell trying to climb over the rails to get out of bed.
  8. by   live4today
  9. by   night owl
    I hate siderails!!! I've seen far too many pts get hurt because of them. I've seen two pts get caught between the bed frame and the rail, a few I've seen fall between the split rails (4 rails), one would climb over the rails and fall to the floor and even found one years ago dangling from the bed in a chest posey. I believe they do cause more harm than good. I've heard stories (one on c-span) where the pt's neck was caught when she fell thru the split rails, broke her neck and of course died. If they have cognitive impairment, they don't understand that the siderail is there for their safety and will try to climb over it or through it! The low-bed works for some, others are on the floor mats more than they are in bed. If a pt truely needs a restraint because no matter what the staff does to prevent injuries, the pt ends up injured anyway is either put the pt on 1:1 for fall percautions, or implement the enclosed bed. 1:1 depleats the staff ( which always seems to be depleated anyway). Facilities hate to use restraints because everyone wants a "restraint free" unit, but in my opinion, SOME PTS JUST NEED A RESTRAINT (ie) the enclosed bed.
  10. by   PhantomRN
    We still use them. I like to put up three and leave one down. Usually the one I leave down is the one that is in the patients line of site to the bathroom.
  11. by   MiniRNC
    I tend to do as PhantomRN. Three up and the one near the bathroom or the side of the bed the Pt gets out on down. If I really want four up, I put the over-the-bed stand the fouth side Instead of putting up the rail. The patient can push it out of the way, so it's not really restraining. Usually I have it so noise is made when they push the stand & then we have a better chance of knowing the Pt is getting up. Most often it is only two up on nonconfused patients or at Pt choice 0 - 1 up. YES they do cause serious accidents!!! Fx necks, arms, hips etc. We've had two deaths in my 12 yrs on this unit. Both fx necks!!! One was restrainted and the other was several hours later when she removed her neck immoblizer! This patient had a weak left arm, but reached over to the left with the right & not weighing much, pulled her self over the rail. I'm still shocked that she did it.
  12. by   Slowone
    thanks for all the responses! It is interesting, siderails are such a damned if you do damned if you don't issue. Our facilty is attempting to be siderail free, but many residents want to have rails as a comfort measure. According to our state regulations, resident safety overrides resident rights as it relates to siderail usage. The facility has the final say as to whether or not they are used. We have many mattreses on the floor but i can't stand the way they look when you walk by. (reminds me of my college years when I couldn't afford a "complete"bed)
    I also think the personal/bed alarms are a joke. They do not prevent falls, only alert you when they have occured...I find that so frustrating. I feel restraints, if used properly, have a place in long term care. I don't know about you all but I am sooooo tierd of filling out incident reports I can hardly stand it!
    Anyway, thank you all again for your sharing. If any facility has found the "answer" to all of this, please let me know!
  13. by   night owl
    I don't think there is an answer to all of this madness!
  14. by   aimeee
    We have lots of low beds around here for patients who are high risk for falls. The CNA's really dislike them when they aren't electric (and who can blame them!) But they really really work. Mats by the bed are helpful, but they are also an unstable surface for the resident to stand on if they do manage to get up. Personal alarms are of limited value. Half the time the resident is on the floor by the time you get to them!

    I once had a resident who was post total hip replacement get caught between split siderails. These were the ones that are sort of diamond shaped. He got his hips wedged into the gap between the two rails with his legs hanging out. I couldn't lower the siderails because his hips were in the way, and couldn't lift him up because the siderails were in the way. It took 4 or us to extricate him. Had to lift him up while supporting his body and turning at the same time to maneuver him out. I was so thankful there was no hip injury.