Ok, we did these things, depending on the pt's level of awareness and condition:
1. Low beds. (Unfortunately, the low beds did not raise for nurses or aides to do patient care, killing my back, especially when dealing with combative patients, and the heckuvit is there are NO rules in place for this for employers from OSHA, only "strong suggestions" --but that's another thread.) True, there were less falls, and we often put another Spanco (soft quilted) mattress alongside the bed for cushioning if the pt. rolled or crawled off.
2. If no low bed was available, we'd push the regular bed next to one wall, and then put a mattress down on the floor next to it so if the pt. got out, they'd land on the mattress. In addition, the pt wore a loud alarm that was set off by a string that pulled out, attached both to their nightclothes and the bedframe.
3. Leave the bed rail down and hook up a patient alarm to the bed and the patient's gown, so if they moved around as if to get up, the alarm would go off and alert staff. Usually those folks had to get up to potty a few times a night. A Bedside commode next to the bed was very reassuring to them. (Doesn't work for pts who take the gowns off before leaving the bed though)
4. Get them outta bed. So they can't sleep. No problem; we all have those nights. We'll sit them in a chair near the nurse's station and walk them, feed them, amuse them, etc, til they're tired. If it happens a lot, could be a clue something's wrong.
Sounds like all you guys need are the patient alarms, jones, so you know who's moving around and potentially getting outta bed.