Remembering to put up bed rails...

[NurseFirst]

Hi,

I just received a notice by my clinical nursing instructor because I failed to remember to put up the bed rails on a patient, and leave the bed in the "down" position.

I'm curious, what have other people done to make sure that they always remember to leave the bed in the appropriate position (whether it is a "side rails" or "no side rails" patient)?

Thanks,

nursefirst

[Tweety, BSN, RN]

If we leave siderails up x 4 it is a restraint and we have to follow the restraint protocol major pain in the butt.

Last month a nurse started an IV for me and left the siderail down and the patient fell out of bed, hanging by his rollbelt. When I think how he could have choked to death I shiver. Siderails are a good thing. :)

[bluesky, BSN, RN]

If we leave siderails up x 4 it is a restraint and we have to follow the restraint protocol major pain in the butt.

Last month a nurse started an IV for me and left the siderail down and the patient fell out of bed, hanging by his rollbelt. When I think how he could have choked to death I shiver. Siderails are a good thing. :)

Thank god I don't have to get a restraint order for where I work! The only time the rails go down in our SICU is when we boost or bathe. There are usually 2 RNs there so if one forgets (which doesn't happen all that often), the other is right there to remind.

[UM Review RN, ASN, RN]

I worked in one place where the resident couldn't get past the 4 siderails, so she stood up on the bed to climb out the bottom, and did a Swedish fall right off the foot of the bed and cracked her head open on the wall opposite.

She won a new bed on the floor when she came back from the hospital with her facial stitches, bruises, and concussion.

(I seriously think that for patient safety reasons, all hospital beds should be able to be lowered onto the floor and then raised to a working height if the patient is deemed a fall risk, but that's just MHO.)

Anyhow, you see this kind of accident happen a couple of times, believe me, you'll remember.

[mattsmom81]

The only time I can put ALL siderails up is if I've documented thoroughly as a fall risk or other risk of harm to self, and obtained orders for restraints (all 4 siderails is a restraint in my state too) So I'm surprised to hear nursing instructors are harping on 4 siderails today.

The bed LOW of course is a major safety issue. Safety documentation q 2 h in my ICU usually includes ' siderails up x 3, bed low and locked, call light in reach and pt agrees to call for assist OOB.' If there is any type of restraint then we have THAT q 2 h protocol charting.

I frequently find my ICU patient's beds in the air w siderails down following a doc, RT or lab visit and they get a stern lecture from this ol' nurse. Safety basics must be committed to memory for ALL in healthcare.

[Roy Fokker, BSN, RN]

Try this technique. Before I leave a pt room, I take a few moments to stop and scan the room. Does my pt have all that they need? Bed in appropriate position, call light within reach, water pitcher ect...Also, have I done everything I came in to do? Are there any other tasks I can take care of now? Believe me, an extra moment now will save time in the long run and guard against safety lapses.

By the by, I think that "siderails as restraints" applies in long term care, but not in a hospital setting. Good luck in school! It will be finished in a blink! Really.

Thanks. I'll keep that in mind.

I must get better at 'mental checklisting' though :-)

[leslie :-D]

in massachusetts they are too, considered a restraint.

i've had patients that have actually tried to climb over them and have injured themselves.

so it's 6 of one, half dozen of the other.

but if there's a top rail, i always put that up, no matter what.