I work part-time at a local nursing home that implemented a restraint-free policy a few days ago. Management removed all of the side rails from the beds and, within four days, more than 20 residents have fallen.
Even though the fall-risk residents have low beds, they are still sustaining serious injuries. There are not enough fall mats to go around. Staffing is being reduced because this particular company is very much profit-driven. Families are frustrated and want the side rails back, but they're being told that the restraint-free policy arises from new federal regulations.
The increased incidence of falls disturbs me to the point where I am now fearful of coming to work because I'll probably have to deal with broken bones, bloodied noses, hematomas, and even worse.
As others have said side rails are only considered restraint when all four rails are up.
Depends on where you are. At my facility they are considered restraints. Our residents are allowed side rails only if they or their responsible party is educated and sign papers. We have beds that go all the way down to the floor and we put mats down. It's a pain!
I wonder if we work at the same facility. I work at exactly same kind of place.. Profit-driven. Patient is having a chest pain or respiratory distress, we cant send patient out to the hospital per DON. I had a patient who definitely needs one to one sitter but of course they wont let us have one and yesterday I got a physician order for restraint for 24 hours until she is evaluated by PT. DON says she cant have restraint. I'm not a nurse at my work. I am a Professional Babysitter and I'm proud of it!! :dncgbby:
Sorry I got little carried away.. But at your facility 20 falls within four days seems like too many falls. Your facility can get into trouble from the state for that. So they better do something better or they are going to be tagged serious time and they are going to pay a lot of money
This has been an issue at my facility also. Two very confused residents have had increased falls (2x a week) because their side rails were taken off.
One because she tosses and turns and rolls out on to the floor.
Another because shes just agitated and wants to get out of bed.(and off to the ceremony). Me- and where do you think you are going? Her- I've got.. the got to get the ceremony of Paul.
They have bed alarms, motion sensors, low beds, mats, room close to the nurses station.
Makes me wonder if they just left the siderails as is. would the fails decrease
Specializes in Spinal Cord injuries, Emergency+EMS.
side rails are and yet are not restraints
the USA remains unique in the acceptability of tying people up for the sake of 'safety' or lawsuit avoidance, as has been seen with previous discussions on both restraint and on appropriate immobilisation techniques for the patient with a potential spinal injury.
side rails on beds are an appropriate tool if used with consent and as a part of a wider set of risk controls, but for the confused or agitated patient they magnify the impact of getting off the bed by increasing the height of the fall and pose an asyphxiation risk , provide a site for the accidental or deliberate securing of a ligature...
beds which go very low or resorting to nursing patients on a mattress on the floor also have their place
I've never worked in a facility that isn't restraint-free, so I don't know any different. I don't think there is a single facility around here that still uses restraints. Full siderails are considered restraints. We don't have any beds with full side rails either. We have our fair share of falls but nothing like what you're describing. I can't think of the last time someone got injured from a roll out of bed.
Is your facility using alarms? All these fallers should have pull, pressure and lazer alarms in bed.
It's ridiculous for the facility to be cutting staffing while implementing this. They are just asking for problems.
Side rails are very tricky. There have been documented deaths because of them and its debated whether are not one side rail, a 1/2 side rail or even a 1/4 side rail is a restraint. In all honesty, I dont think a patient should have them (in a LTC facility). Think about it...they pound in our skulls that "This is their home..remember, you are in THEIR home"...well...at home did Ms. Jones have a side rail "to keep from falling out of bed". Most likely not. The main purpose for side rails is bed mobility by the resident. If a resident is able to pull themselves over or up in the bed with a use of the side rail, then it is not considered a resident. If a resident is climbing out of bed, they will get out of bed whether or not a side rail is in place. They could suffer more injuries if they tried to climb out of bed with a side rail. Here is what I think.
I think you should find out why you had 20 falls in 4 days. What was the resident trying to do? Did they need a drink? Go to the bathroom? Whenever I have a fall, I always ask my resident what they were trying to do when they fell. I then can base my new interventions on what they say what they were wanting to do.I had one lady that fell every night at the same time. Very very confused and very fiesty. She would hit, kick and scream. I sat down next to her and just listen to what she was saying. At that time, I did not try to re-orient her. I wanted to know where she thought she was at. Turns out, she was thinking it was time to feed her twins girls. Every night at 3am, she would get up, change the babies and feed them. So, we careplanned it for the staff to toilet her 1st on 2nd rounds and then ask her if she wants to feed her babies. If she says yes, we sit her in the recliner with two baby dolls and she falls alseep feeding them. If she says no, she goes back to bed and sleeps the rest of the night.
At my facility, we too are a restraint free facility. No full rails period and MUST have a MD order for 1/2 or 1/4 rails. Our next phase is to remove the alarms we have. We are very slowly doing that as well as the antiphsycothereaputic drugs. We are using a program called Awakenings, a rehab program for the residents.
To prevent more falls, be sure the residents are toileted and also given plenty of water. Just because the CNAs pass the water, doesnt mean the residents drink it. Offer water with each med pass. Make sure residents who are unable to pick up the cups, are offered water. Nothing frustrates me more than walking in a room, finding the residents ice water full with the straw still wrapped and out of reach from the resident. I mean, really? Its comman sense!! I would bet a paycheck if you went back and looked at those 20 falls and 95% of them need to be toileted (or changed) or just wanted a simple drink. Hugs...I feel for you..now stand up and be proactive!!
Hmmm....just finished doing a mental walk thru of my resident's beds. Those who are agitated have very low, concave mattresses and pads on the floor. They also have bed and chair alarms. The folks with side rails are alert and use the rails for mobility.
What about the use of cross belts and those lap pads on wheelchairs? We use those...thankfully. Our residents can roam our entire building which has 120 beds.
A few weeks ago I had a clinical rotation in the ER. A LOL came in with a third hematoma on her forehead, she'd just been released back to her LTC that morning after a fall the day before. Tragic.
at home did Ms. Jones have a side rail "to keep from falling out of bed".
Medical supply stores do sell side rails for regular home beds and people use them. A resourceful family might push a dresser up next to the bed to function as a side rail (I don't recommend it, but I've seen it). There may be many reasons side rails are a bad idea, but the fact that most people don't have them at home doesn't seem like a strong argument against them to me.
I understand that a really determined, agitated patient might very well climb over side rails and end up taking a greater fall than without siderails, or get wedged under the side rail and suffocate. Side rails and other restraints certainly pose several risks, but no restraints without full-time sitters poses its own risks, doesn't it?
Specializes in Gerontology, Med surg, Home Health.
Really...all y'all need to get your facts straight before proclaiming something on here. I work in the most regulated state in the union and we are allowed to use restraints. Of course there has to be a valid reason and an assessment. As for what is or isn't a restraint....if you put a hoyer lifted resident who can't walk into a recliner, it would NOT be a restraint since that person couldn't get up if they were in a regular chair. If, however, you put an ambulatory resident in a recliner and lift the feet to prevent them from getting up, it IS a restraint.
A half side rail could be considered a restraint if it prevented that particular resident from getting out of bed. NONE of our beds have full rails....most have 1/4 rails and if we put them up, we document that they are enablers to help the resident turn side to side.
There was a facility on Cape Cod that received a tag because they DIDN'T use a restraint and the resident had a documented history of falls with serious injury.
As with everything else we do, assess, assess, assess and then document, document, document.
We call my facility a 'restraint appropriate' facility.
Wow, this sounds like a policy written by an out-of-touch bureaucrat who read an article and dreamed up this brilliant policy. What could go wrong? We'll be leaders in health care! Hopefully they will revise their idea.
Really...all y'all need to get your facts straight before proclaiming something on here. I work in the most regulated state in the union and we are allowed to use restraints. Of course there has to be a valid reason and an assessment. As for what is or isn't a restraint....if you put a hoyer lifted resident who can't walk into a recliner, it would NOT be a restraint since that person couldn't get up if they were in a regular chair. If, however, you put an ambulatory resident in a recliner and lift the feet to prevent them from getting up, it IS a restraint.
A half side rail could be considered a restraint if it prevented that particular resident from getting out of bed. NONE of our beds have full rails....most have 1/4 rails and if we put them up, we document that they are enablers to help the resident turn side to side.
There was a facility on Cape Cod that received a tag because they DIDN'T use a restraint and the resident had a documented history of falls with serious injury.
As with everything else we do, assess, assess, assess and then document, document, document.
We call my facility a 'restraint appropriate' facility.
I sounds like your facility does is right, assess and act accordingly and appropriately. It sounds like the original posters's facility just made a foolish unilateral decision without putting in place all the other tools that would be needed to make the transition safe.
Specializes in LTC, ER, ICU, Psych, Med-surg...etc....
A restraint is only a restraint if it prevents a resident from doing something or having access to their body IF they want to. A side rail is NOT a restraint unless you are using it to keep someone in who is trying to get out...however, if they are trying to crawl out over the rails it is a terrible hazard! If it is only to define the parameters of the bed so the resident doesn't roll out, then it is not a restraint. There are various sizes and I have seen 3/4 rails- almost but not quite all the way to the end of the bed, and it is not a restraint. Your company is setting themselves up for not only horrendous citations from the state but also lawsuits but most importantly- residents injured and in pain. There is a way to go about being "restraint free" and that doesn't mean just going in and ripping all the siderails and stuff off....there has to be a plan and a each resident has to be assessed individually. You gotta invest in the things to keep people safe. Alarms are no good if you don't have the staff to answer them or if you put them on everybody in the house and everybody gets so desensitized to them that they no longer hear them...fall mats are great, but they have to be down and rounds have to be made to ensure the mat is correctly placed....Geeeeez....People are crazy. Listen to CCM...she has been around and has great ideas and experience.
I mean, really? Its comman sense!! I would bet a paycheck if you went back and looked at those 20 falls and 95% of them need to be toileted (or changed) or just wanted a simple drink. Hugs...I feel for you..now stand up and be proactive!!
DizzyLizzyNurse
1,024 Posts
Depends on where you are. At my facility they are considered restraints. Our residents are allowed side rails only if they or their responsible party is educated and sign papers. We have beds that go all the way down to the floor and we put mats down. It's a pain!