Need help with policy for bedrails as restraints in ICF DD facility

Carlos Casteneda · Jun 22, 2005

I'm a RN consultant for 3 ICF DD-H in California, I'm in need of a policy and procedure on bedrail use. I would appreciate any help I can get. I also have forms, various policies I'm willing to share. Thanks.

what a big subject you chose in england we have had several deaths from bedrails so we have major policies main thrust is risk assessment can provide info if you still require

HowieH RN · Nov 13, 2005

Julian Dodd,

In our facility we use bedrails on most of the beds. Some beds are very close to the floor and for those "guys" they can get out and crawl around. On the beds with the rails our maintenance dept. devised padded boards that cover the rails. These boards have been approved by the state and work well. If you need a picture let me know and I'll see what I can do.

yankeesrule · Nov 22, 2005

I work in an IRA (similar to a ICF) in a dev disabled facilty. When anyone is deemed as the need for bedrails when that individual team involved, case worked, coordinator, nurse, physical therapy. We then reveal their abilities v/s disabilities and diagosis. We also speak with the staff moreso the nightshift and ask them their sleep patterns. Seizure patients another hot topic. The facility I work at is trying to faze out bedrails. People know with aging population, dementia, disabilites ect.. not going to happen. We have started to use bolster mattress. These are great and have eleminated the need for b/rails for many. So the policy for rails typically go into effect for those who have no ability to protect themselves from falling (parapelgic.. I cant spell tonight) seizures. We too use the lower to the ground method. Those who can roll in bed but cant walk or use their arms legs for support but do have movement in an limb. We have a bedrail safety checklist and there is a grid if they have so many yeses then the person needs an eval. hope this helps ..

jpennybaker · Nov 22, 2005

I only wish to say that side rails IMO are dangerous just because of the 'up and over' factor. Lowered beds may be safer for patients but I vehementally diasappove of these for the simple fact that staff should not be put in a position to harm themselves as this kind of arrangement would require. I can't stand to see nurses and CNAs attempt to move and lift patients from a lowered postion.

yankeesrule · Nov 22, 2005

I agree with the last post about staff leaning down and up to lift. But again that is why there are lifts (sarita, hoyer, ect.. if applicapable) another option is these padded rails that are great. They are not removable they are smooth and no way for someone to get a hand, head thru. There is always going to be an issue with people getting up ect.. For that we have a matt under their sheets that signals someone is getting up and wont stop till we shut if off. This is for those who have risk for falling.

schoedr · Nov 23, 2005

I have worked in an RHC for the past 18 years. We never use bedrails as a restraint, but we do have clients who use bedrails for safety and positioning purposes. They are used only when we have approved them as part of a team, safety issues have been addressed, and modifications have been made where necessary. For those whose who have spasticity and may have limb injuries, we may use four-sided plexiglass around the rails to prevent injury or entrapment. For those who can climb, or are ambulatory at all, we do not use bedrails- we use floor pads with safety alarms instead. All their beds are low. For clients who are positioned in wedges and need the siderails for positioning (non-mobile clients), we have positioning guidelines written by ot and justification for use of bedrails (emphasizing, again, they are not for restraint, but for positioning). We also require all parents or guardians consent for bedrail use. I write a careplan for all our clients who need siderails adrressing areas of safety, comfort, etc.. Hope this helps!

Frances (UK) · Jun 24, 2009

Hi

Bedrails are a difficult but important topic! I appreciate that legislation is different in different countries but there are a lot of free resources at this UK link, including bedrail posters, slides for training, and a 'model' bedrail policy at:

http://www.npsa.nhs.uk/nrls/alerts-and-directives/notices/bedrails/

For the more academically minded there is a sytematic literature review on bedrails at http://ageing.oxfordjournals.org/cgi/content/abstract/afn112?ijkey=XDvehPVFrz8khs0&keytype=ref

best wishes

Frances