Sian

You could consider siderails a form of restraint in that they fit the broad definition of limiting the freedom of the patient. However, we don't treat use of siderails in the same way that we treat use of other physical restraints eg shackles, because we don't obtain authorisation for use or document checks. You should always document your use of side rails, and check regularly on the patient. I think you would be more negligent in letting a narcotised patient fall than in putting side rails up, but i think you'll find this is a grey area in a lot of places. Certainly if a competent patient refused to have the rails up ( and full explanation should be given and permission asked before putting up the rails) you should comply with their wishes and document this. We find on our unit that side rails in the acutely confused or delerious can sometimes do more harm than good; at the first sign that the patient is trying to climb out of bed, the mattress is placed on the floor. With the adoption of a falls risk assessment program, we decreased our falls a lot in acute medical.