Siderails in LTC - page 2

In the facility where I work we have been slowly eliminating siderails. State guidelines say that siderails are a restraint, also there is a risk of being entangled in rails. So we are replacing SR's... Read More

  1. by   jones58
    Our low beds have remote controls to raise/lower the height of the bed. A month or so ago, one of our pts got hold of the remote and while in bed raised the bed to the highest position, probably shoulder height. No harm done. He was found sitting on edge of bed with a big smile, swinging his legs. Way up there. All documented and remote tucked away where he could not find it anymore.
    But can you imagine what might have happened?
  2. by   sandyth
    We use full srs, low beds, tabs monitors, mats on floor for protection, wedges between rails. you name it we use it. Pt safety is goal # 1.
  3. by   huganurse524
    That is actually something I just found out during orientation at an acute care facility. In LTC side rails are a form of restraint but not at the acute care facility or hospital so they are used without consent.
  4. by   caffine addict
    Jones 58
    Back to your original message. What did the care plan say? That the resident would be free from falls? Or the resident would be free from injury? If they fell and had no injury then you were sucessfull. After all you expect that they will try to get up and fall thats why you use the floor mats. Anyhow, everyone else is right nothing is going to stop a confused resident. Sometimes the low beds are not the correct solution. The harder we make it for them to get up the harder they fall. If the bed is the proper height for a safe transfer and the resident gets PT or restorative ambulation for gait and balance training they may be at a lesser risk for falls.
  5. by   slinkeecat
    We use siderails in this LTC facility that I work parttime. We did have to justify them so we had write lame orders like

    SIDE RAILS x2 to aid patient in mobility in bed

    then we have to document:

    Pt utilizing side rails to turn over in bed during incontinence care.

    Well, Well, Well...

    We have bed alarms, but the pt's I have are clever and can shuck them off in the blink of an eye.....

    My most unhappy experience was with a pt who had side rails and they were padded with these gym mat like padding and some how she managed to get pinned between it and the rail and she suffocated. It was a very horrifying accident. I hate those pads... It was awful.
  6. by   jjjoy
    Sometimes the solution is more dangerous than the problem!

    How about nurses spending less time documenting rational for every last tissue handed out, less time constantly readjusting everything to ensure that one kind of accident "never" happens again (e.g. falls), and had more time to spend with the patients - to recognize agitation before it gets to a crises point, to have time to transfer a restless pt from their bed to a wheelchair in the community room, etc... Sigh, I can wish...
  7. by   jones58
    Its been over a year since my original post. Both of the pts I referred to have expired (not related to a fall out of bed)! We're having good luck with our reduced siderail programs, but not very good luck with our reduced staff programs. Its very difficult to answer 2 bed alarms at the same time. How do you decide which pts are getting out of bed and which ones are turning over? We have the bed alarms that are a strip that goes under the mattress and sensitive to the pts movement. I honestly think some of our alarms are so sensitive they are triggered by flatulence.
  8. by   ktwlpn
    Originally posted by greer128
    So far it is wroking ok, I still believe that a few res, need restraints though, because nothing else seems to work.
    The measures that I find most effective is to put the resident to bed only when they are clearly good and ready to go-after toileting,a snack and a drink and maybe extra strength tylenol has been given.At the first sign of restlessness we get them up and repeat the above-and sit them in our sitting area in front of the nurse's station until they appear to be ready to go back to bed again...and document.Nothing worse then sending a resident to the er for evaluation of lethargy when they were awake all night and you were not told during report....Staff must remeber that sleep disturbances often go hand in hand with dementias...
  9. by   nurse62
    We have used all the techniques as well. Low bed, half side rails, alarms, etc. Full side rails x2 as an enabler is a restraint. However if patient is unable to reposition themselves in bed to prevent a possible fall, we use full side rails x2 as a safety measure. However, if we use the side rails and the patient is climbing out of bed, the siderails then become more harmful than not having them at all due to the distance of the fall would be greater. Thus, we reform to a low bed, alarms, etc. Most importantly, if a patient is climbing out of bed. Get them up. Toilet, feed, walk, they don't fall. Easier said than done, I know.
  10. by   LPN216
    First of all.....SNF stands for "Skilled Nursing Facility". Or the skilled unit withing a Long Term Care Facility. This is the unit that is utilized for post hospitialization pts, or those expected to be shorter term stays. Once discharged, they can go home, to another facility, or be placed on a long term wing or unit within the current facility.

    Second.....if you have someone you just dont feel comfortable leaving without a plan it as "an enabler". This will allow you to leave the 1/2 siderail up, and the patient or resident can use it for balance, helping to turn, or helping to pull themselves up to a sitting position. Many times the reason for a fall is that the person is trying to reach for the nightstand to hold onto, or worse yet, they reach for the overbed table (with wheels), and lose their balance.

    Just a thought.
  11. by   STM
    Originally posted by shygirl
    We cannot put the beds against the wall, that is considered a restraint. we have siderails only if it's documented that patient has fallen out of bed or gets up unassisted. We use monitors that beep, low beds too

    At our SNF we have hall monitors on occasion who do nothing but walk the halls, checking rooms and brakes and rails, and patient safety. Which still isn't enough sometimes. We also have bed alarms, w/c alarms, low beds, half rails, and if the supervisor feels restraint is needed, as in rails, they can write an order for it for a 24 hour period. That helps get us through the night...sometimes. But falls are going to happen. No matter what you do, some are going to fall regardless...or have a skin tear, etc. Even with the bed alarms, sometimes you just can't get there quickly enough as it is.
  12. by   sixes
    Siderails is considered a reatraint where I work also.
    It is far better for a resident to fall out of a bed in it's lowest position then have them go over the rails.
    We have low-low beds. 6" off the floor and low beds about 2' off the floor. they all raise to normal hieght s for nursing care.
    The low-low beds also discourage getting up with out assistance as there knees are usually too bent to facility getting to a standing positon.
    As for call bells being attached to lothing there is a risk that the resident will strangle themselves with it. we are allowed when we have an order to use siderails string it across the siderails at waist level to alert staff that they are trying to go over the rails. I have seen this method fail and injuries occur.
    I wish someone would invent a tent like enclosure that could be attached to the bed frame, therby facilitating movement with out danger (no falls, no posey restraint, no siderails, no chemical restraint) and also be environmentally friendly, allowing the resident to see, hear and most of all not die of heat