Side rail stories

[Bringonthenight]

What are people's opinions on the use of side rails? In most facilities I have worked we put side rails up on falls risk patients or just at patient request.

However in one state I worked, no public hospital had side rails on any of the beds. I asked the hospital interview panel why, and they all laughed that I had brought up such a ridiculous question. They said evidence based practice shows side rails cause more damage. Patients climb over the rails and fall or get caught in the rails and injure their arms/legs/necks. They said regular rounding, lowering the bed to the floor were the best ways to reduce a fall, but if a patient is going to fall, a rail won't stop them.

I felt so odd not having the option to put up my confused fall risk patients rails.

What are your opinions? Are you for or against the use of side rails on patient beds?

[Morainey, BSN, RN]

We put two siderails up at the HOB because they have little nurse call buttons and the patient can adjust the head or the foot of the bed. We can technically put three up and it won't be a restraint, which I will do sometimes if someone is sloooowly migrating their leg off the side of the bed, such as a confused elderly person. However four siderails is considered a restraint. FWIW in the nursing home I worked in long ago their policy was to have only two siderails up, their logic being, if the person really wants to get out of bed side rails won't stop them and in that case they would put pads next to the side of the bed and have the person checked frequently. In fact they were probably more likely to get injured climbing out over the siderail.

[JDZ344]

The nurses where I work have to do a ridiculous amount of paperwork to put rails up. It's easier all around to leave them down unless the person is alert and wants them up!

[Bringonthenight]

We don't have to do any documentation on putting up side rails. I don't get what the big deal is?

[JDZ344]

We don't have to do any documentation on putting up side rails. I don't get what the big deal is?

A few cases of people getting arms/legs trapped in bed rails. At least here that's the reason.

[blackvans1234]

I would like to read the EBP study that shows bed rails cause more falls than prevent more falls.

I could see the argument that there are more serious injuries with bed rails, as the fall distance is greater, but bed rails coupled with bed alarms seem like a good idea.

[Music in My Heart]

While I was in nursing school I read a couple of articles pertaining to side rails and found just what was related to you: That side rails are associated with an increase in injurious falls without a marked decrease in absolute number of falls.

That said, I find side rails useful with patients who tend to slide around a bunch but gap bridges (pads between the head and foot rails) should be used to minimize patients sliding out between the rails and getting trapped.

The only things that really reduce falls by confused patients are sitters, lap belts, and floor beds.

[Staragate, ADN, ASN, RN]

My facility has itty bitty "grab bars". It helps the patient grip the bar so she can turn and repostion by herself or with help. Otherwise, we don't have them. In my LTC, side rails are considered a restraint, but grab bars are not. *shrug*

[anon456, BSN, RN]

I work in peds and we find siderails useful to protect patients from accidentally rolling out of bed during sleep or in the case of the total care kids who might shift a bit in bed. For the ones who can't be trusted to stay in bed even with side rails we have either climber cribs for kids up to age 2-3 (look like cages), or the posey beds (tents that zip up) for bigger kids. We also heavily use sitters. I could not imagine not using side rails. Even on the mature patients teens and adults (yes we get adults at the peds hospital sometimes) they choose to put the top siderails up on their own probably to prevent slipping out of bed when the HOB is raised.

[hodgieRN]

No side rails on a s/p head bleed/stroke....not on my shift.