SIDE RAIL ALERT

[km rn]

Throughout my nursing career, side rails were seen as a benign safety device. The standard used to be that side rails were automatically used for all patients.

However, side rails are not the safe medical device we all thought they were. Each year 40 patients die secondary to side rail use. How - patients become trapped with their face pressed against the matress, have their neck caught between the rails or are trapped between the side rails after sliding partially off the bed. In addition, another 225 injures can be attributed to side rail use. However, it is important to note that not all deaths/injuries from side rails have been reported.

NOTE: yes - side rails remain appropriate for some patients. However, they should never be automatically used without assessing the dangers associated with their use.

Uninformed people state that they use side rails to prevent being sued by a family if a resident falls out of bed. It is important for us to continue to educate ourselves about changes of practice. Research has shown that restrined persons are twice as likely to fall and three times more likely to sstain an serious injury from a fall then a unrestrained person. Side rails on a bed will cause greater injury if a resident climbs over them and falls to the ground. In addition, the possiblity of entrapment and suffocation from side rails exists.

HCFA's Side Rails Interim Policy (2/4/97) notes that all types of side rails (full raisl, half rails and split rails) may pose an increased safety risk.

The FDA issued a FDA Safety Alert: Entrapment Hazards with Hospital Bed Side Rails in 1995.

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Articles - Deaths Caused by Bedrails - Journal of American Geriatrics Society 45:797-802, 1997

An Analysis of Falls in the Hospital: Can we do without Bedrails? Hanger, Ball, Wood. Volume 47,Number 5. May 1999. Jounal of American Geriatrics Society.

There are multiple (>50 articles) related to the risks of side rails - I had the most luck utilizing a search - medical devices side rails on beds.

HCFA's National Restraint Reduction Newsletter Summer 2000. http://www.hcfa.gov/p...sletters/restraint/2000rr0600.asp

Untie the Elderly - http://www.ute.kendal.org/archives/jul99news.htm

In our efforts to educate staff, families etc. about side rail dangers, we have made a binder of these articles.

PLEASE TAKE THE TIME TO EDUCATE YOURSELF ABOUT THIS TOPIC. THE DEATH CAUSED BY BEDRAILS HAS GRAPHIC ILLUSTRATIONS OF HOW PEOPLE HAVE BEEN KILLED BY SIDE RAILS. THINK BEFORE YOU AUTOMATICALLY PULL UP THE SIDE RAILS.

PLEASE LET ME KNOW IF THIS IS A HELPFULL ALERT FOR YOUR.

[2LTCnurses]

In LTC settings side rails are a big no no. On admission, we have to automatically get an order for 2 siderails DOWN, then re-eval after 3 days. The theory is that we will only use them IF a need for them has arisen, and then they can only be used if the resident needs them for repositioning assistance. They must also be able to demonstrate this to a state inspector on request. A 3 day assessment of side rails is done on admission. If the family chooses to request rails for an incompetant resident, then it must be treated as a restraint with all the documentation, reduction attempts, etc. They also feel that in addition to being trapped in the rails, that if they are confused and try to climb OOB, they will go OVER the rails......in effect falling farther than if they were down. We have Ultra low beds, mats on the floors, alarms..all sorts of alternatives to side rails. Even if they need them to reposition and can demonstrate it, if they want full rails instead of half rails, they have to sign a "dual side rail request form".

My biggest task is getting the CNA's to comply with the MD orders!!! We use colored tape to indicate if the rails should be up or down......but I constanly have to go behind them and make them do it correctly....they LOVe to put the rails up...especially the aides from the "old school"!!LOL!

[princessangel]

At my hospital we use cot sides (side rails) for patients thought to be at risk of falling out of bed. This is assessed informally (experience not tool) by a nurse, and information passed on at report and sometimes recorded in notes.

I had a patient that I assessed as being at risk of falling from bed due to inability to ask for assistance with toileting. This patient had a pressure overlay on his bed and so i decided that cotsides were innappropriate as the mattress height was raised too much for any protection to be offered by siding.and i didn't want him to use sides for leverage to get out of bed. I instead put the bed onto its lowest setting and put the patient in the best observable bed and explained to him why he should ask for assistance. This patient fell out of bed whilst staff were working with another patient behind curtains and sustained a sub dural heamatoma and subsequently died. This case went to coroners court where it was agreed that all preventable measures had been taken. The family were dissatisfied with this and I can't disagree with either opinion. SO, am now very aware of concerns around use of cotsides but there is no perfect, scientific, medical, applied rational for use of sides as far as I can make out. Any ideas??

[NRSKarenRN, BSN, RN]

Princessangel:

The topic of siderails came home after my 92yo grandmom fell 2 days in a row while in assisted living facility (She has been increasingly falling over past 4 months at home prior to April placement.) This time she injured her cocyx bone and was unable to turn or pull heself up in twin bed and suffered severe pain on movement. I spoke with NP and we got a hospital bed with 3/4 rails so she could get to commode. Within a week with adequate pain mgmt and LPN's/HHA's support,= she was a contortionist in bed with her head at the bottom. Three weeks later out of bed, WC mobile and refusing to go back into hospital bed with rails--sleeping in empty ajoining twin bed but severly hampered entering/exiting and boosting herself up. Much discussion with her staff, myself and PT-- decision to leave rails down in daytime; change to 1/2 rails for evening and bedtime. Now back in own hospital bed. No falls and improved independence.

Today, AJN magazine arrived---great article on siderails including a decision tree for side rail and alternative intervention.

Check out AJN, July 2001,Vol 101, No.7, PG 43-48.

End of article gives list of companies carring alternative to siderail equipment. I do not see any of this in use in home care and assisted living facilities in my area, but plan to discuss with our Home Care agency PT department and local DME providers.

Thanks for the info.

[night owl]

side rails are a big danger as far as i'm concerned. i had an experience that i'll never forget. it was about 4am and the cna called me to come to the patients room quickly that he was stuck between the side rail and the mattress. he had the split rails on his bed. apparently his legs went down the split and his torso was wedged between the upper rail and the mattress frame. luckily the only injury he sustained was an abraision on the left side of his torso. when we first got into the room, he was just hanging there and looked awful! the supervisor happened to be making her rounds at the time and helped us to get him unstuck and back into bed. thank god we had an empty bed that had no side rails. it was a low bed and had the matts that you put on the floor. the next day every single bed that had split rails were removed from the nursing home.

as i was scanning the tv one morning with the remote, i came upon a woman on c-span telling her story to the legislative body how her aunt died in a nursing home by the same kind of side rails. she died because she fx her neck between the rail and the bed frame. how sad...so if your facility has these side rails, please before another incident occurs, get rid of them as fast as you can. they are nothing but a disaster waiting to happen...