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.
Specializes in Gyn Onc, OB, L&D, HH/Hospice/Palliative.
We aren't allowed ( inpatient hospital) can use upper two, X4 considered a restraint and the pt can harm themselves more if they are up and they climb over them
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.
Us too, but I think the OR and PACU have different rules because our pts are not in their right minds post op. Restraints are used but still as a last resort. They are needed sometimes though. Some people wake up wild and try to climb out of the stretcher. Or they're trying to yank out various tubes.
Old habits do die hard as pointed out. We were always to check that the side rails were up unless we knew for sure that the pts were A&O x3 and mobile. It's hard to break that habit.
Where I am now, the have mats on the floor and alarms for if the patients try to get up. The unit is huge though and you have to track down where the screeching is coming from. OTOH, I've seen horrible falls from people trying to crawl over side rails.
An aside: When I had delivered my 3rd child, I had the siderails up on my bed when I first got to the room. We were supposed to call the nurse for the first time we needed to pee and I did. And I waited. And I waited. I couldn't get out of bed because of those darned siderails and it got to the point that I was seriously considering climbing over the foot of the bed to get out. That's when I realized how awful side rails really are.
In our facility they removed all the full rails and replaced them with 1/2 rails at the top of the beds. Our fall rate went through the roof! The majority of our patients are elderly and confused. There are a few full rails in house and we have to screen the patients if they need them. We have bedchecks, but imagine 7-8 bedchecks going off and only 4 or 5 staff members on the floor! This on a floor with 35 beds, med/surg/telemetry/oncology! Someone is going to fall. The policy states that if a full rail is needed and not available, then there needs to be a 1:1 watch. Of course there is never enough staff for that. We've been asking for new beds, more bed alarms and more staff but management believes we should make do. In the meantime, guess who's being held accountable for all the falls? We are. I just tell everyone to document when full rails, bed alarms or 1:1 watches are not available. That way the facility can be held accountable, as long as we have done everything possible to prevent the fall.
I'm a nursing student and we're taught that rails x4 are considered a restraint and a Dr.'s order is needed for them, but they are teaching us to always leave the pt with rails up x2.
We're still at our first clinicals site and the beds don't have any rails, can move all the way down to the floor, and mats are placed on both sides. Personally, it scares me that there aren't any rails at all (it seems like it would increase falls) and it seems like it would be harder for the pts. to move around in their beds, but I was told that a pt. was caught in the rails and strangled to death so that's why they don't have any rails.
GrumpyRN63, ADN, RN
833 Posts
We aren't allowed ( inpatient hospital) can use upper two, X4 considered a restraint and the pt can harm themselves more if they are up and they climb over them