side rail use in private duty homecare

[Nursing.capps, RN]

HI, have a question. Home care client has a hospital bed. If I use upper and lower side rails with this client, is that the same as facility nursing where all side rails are considered a restraint. I do private duty home care 12 hour night shifts. There are no orders concerning side rail usage. The family don't care if we use them or not. The case manager just told me to do what I thought needed to done to keep the client safe. I know in facilities where I have worked prior to this job it is considered false imprisonment. Am I doing wrong by using full upper and bottom side rails with this client?

[OrganizedChaos, LVN]

How is it considered false imprisonment? When in the hospital you are suppose to lower the bed & put the bed rails up for safety. I have never heard of side rails be a form of restraints.

If the patient is a fall risk, clearly put the side rails up. If it is a child I would put the side rails up regardless.

[SarahMaria, MSN, RN]

All side rails being up is considered a restraint.

[rnrg]

Yes, the above is true, SR UP X4 is considered a restraint unless otherwise dictated for safety purposes IN A FACILITY. Home care is always different. In a pediatric environment we do not typically have pediatric cribs, we use regular non drop side cribs. I always document SR up X4 because anything else would be a lie, is your pt self ambulatory? Are SR usually upx4 ? Ask some of the long term nurses on the case, they should point you in the right direction.

[OrganizedChaos, LVN]

I did PDN for years & have never heard this.

[Nursing.capps, RN]

Thanks everyone for your replys. The client is 80 years old can not walk only stand to pivot for transfers. I just feel uncomfortable leaving 4 rails up. I usually do 3 so he can help himself with bed mobility. I know nursing home and home care are very different. Just didn't know if all rails up at home is viewed the same as all rails up in a facility. These days you have to be so proactive yourself to protect your license in a world where people are sue happy. Thanks again.

[OrganizedChaos, LVN]

Thanks everyone for your replys. The client is 80 years old can not walk only stand to pivot for transfers. I just feel uncomfortable leaving 4 rails up. I usually do 3 so he can help himself with bed mobility. I know nursing home and home care are very different. Just didn't know if all rails up at home is viewed the same as all rails up in a facility. These days you have to be so proactive yourself to protect your license in a world where people are sue happy. Thanks again.

Definitely don't ask the family. They will say one thing but then say another. If you can look through old notes or ask another nurse that is on a case. Never trust a family.

[AmyRN303, BSN, RN]

In ICU, 4 side rails up is not considered a restraint in my facility. Home care is different. Without knowing more about the situation, I couldn't speculate, but if a patient who can only stand to pivot to a chair had any sort of inclination to get up and out of bed, ie, dementia or any impulsivity, I'd have four side rails up for safety.

[am27]

How is it considered false imprisonment? When in the hospital you are suppose to lower the bed & put the bed rails up for safety. I have never heard of side rails be a form of restraints.

If the patient is a fall risk, clearly put the side rails up. If it is a child I would put the side rails up regardless.

Nursing School 101

[NRSKarenRN, BSN, RN]

Rail use should be specified on your 485 physician plan of treatment as safety precaution + aide in re-positioning himself in bed.

That way everyone is following same level of care and covered in case family objects--especially if they fall.

A Guide to Bed Safety Bed Rails in Hospitals, Nursing Homes

2014 FDA: Bed Rail Safety

Recommendations for Health Care Providers about Bed Rails

[Nursing.capps, RN]

Thank you. This is very helpful.

[blackribbon]

For the nurse who is wondering about how 4 rails up is considered a restraint, evidence based nursing has show that there is a significant risk of injury related to patients attempting to exit a bed over a side rail. Each level of care has different criteria. I know that on a med/surg floor we can't use more than 2 rails at a time. A sitter must be used if we are concerned about safety from a dementia patient trying to exit the bed when they are not safe to do so. A posey vest is also considered "restraint". So are wheelchair lap trays and seatbelts that can't be removed by the patients. You can be legally charged and lose your license if you hinder the free movement of a patient (a constitutionally protect right) without a doctor's order.

I don't know how this is applied to home care but I'd be very careful. If you only have one patient, I'd assume that you'd be expected to be watching that patient while on the clock like a sitter does at the hospital.