Side rails x 4 and falls

[FireStarterRN, BSN, RN]

It came up in another thread. My impression is that current research indicates that side rails not only don't prevent falls, but can contribute to them and their severity. I think side rails x 4 are considered a restraint.

Logically, falls don't result from people rolling out of bed, but from them getting out of bed but being too unable to safely ambulate. Confused or unsteady people will climb over side rails which will contribute to their likelihood of falling and to the severity of the fall.

Yet, I routinely still find side rails x 4 up on my patients.

[mpccrn, BSN, RN]

in my institution, 4 rails is a restraint and needs a doc's order q 24 hours, a restraint sheet documented on q2 hours by nursing

[racing-mom4, BSN, RN]

They are also considered a restraint in our facility. We do have bed alarms with 3 setttings, the highest setting does let us know as soon as the pts shoulders are off the bed, but if they are quick all the alarm does is let us know they are up.

[CoffeeRTC, BSN, RN]

Yah know...our facility is side rail free. None, just little grab bars on the top of the beds on both sides. At first we were leery. Yes, they do cause harm, but they are still nice to have when you are turning pts in bed and just for them to grab on too. Now we have the beds that go so low to the floor they can just roll out. We do have mats beside the bed too.

It is a big change. Many of us have been drilled to always check for side rails up before leaving the room. I still catch myself.

[Tweety, BSN, RN]

Here Sidreals X4 is a restraint and we need a doctors order.

But like the person above, old habits die hard.

[Spidey's mom, ADN, BSN, RN]

Here Sidreals X4 is a restraint and we need a doctors order.

But like the person above, old habits die hard.

Same here - we don't routinely use side rails.

steph

[DA314]

In my school we are taught that bed rails are restraints that require Dr. orders. The instructors stress the importance of lowering the bed to the lowest level and lowering the bed rails before you leave.

[loriangel14, RN]

We use rails x 4 and we don't need an order.We also have some beds that go right to the floorand we try to use these for the climbers.

[racing-mom4, BSN, RN]

NOw I have had alert and oriented patients request all rails be up because they are used to sleeping in larger sized beds at home and they are afraid they will roll out. In that case, I put them up and document per patient request all rails up and patient has demonstrated appropiate use of call light system.

[TopazLover, BSN, RN]

I don't see the issue of impingement injuries listed here as a reason not to use all 4 rails. Last I read, admittedly a couple of years ago, 30% will result in serious injury or death.

This is why I was surprised to see the news article use side rails x 4 as something the nurse should have done in the $1,000,000 case discussed in the other thread recently as well as the obvious climbing issue.

[noc4senuf]

The rails on all of our beds have been removed. If therapy deems that they are needed for bed mobility, we attach one or two half top rails. I haven't sen bottom or full rails in about 10 years.

[ayla2004, ASN, RN]

we have full length side rails. we asses each patient as to have them, some ask for them if we need an air mattrest these are wider so we routinely use them.