Siderails in acute care

Sian · Aug 11, 2000

You could consider siderails a form of restraint in that they fit the broad definition of limiting the freedom of the patient. However, we don't treat use of siderails in the same way that we treat use of other physical restraints eg shackles, because we don't obtain authorisation for use or document checks. You should always document your use of side rails, and check regularly on the patient. I think you would be more negligent in letting a narcotised patient fall than in putting side rails up, but i think you'll find this is a grey area in a lot of places. Certainly if a competent patient refused to have the rails up ( and full explanation should be given and permission asked before putting up the rails) you should comply with their wishes and document this. We find on our unit that side rails in the acutely confused or delerious can sometimes do more harm than good; at the first sign that the patient is trying to climb out of bed, the mattress is placed on the floor. With the adoption of a falls risk assessment program, we decreased our falls a lot in acute medical.

Trauma Columnist · Aug 13, 2000

I work in a large/busy ER and am very careful to chart the bedrails up x2 and call bell in reach. If the pt refuses, I also chart that. We have very detailed restraint orders which RNs can implement without MD order but our documentation has to be in order too.

JillR · Aug 13, 2000

We consider side rails a restraint if the patient could otherwise get out of bed on their own. Our policy is to have at least one side rail down for the patient unless the patient is having seizure precaustions, ect. If the patient requests the side rails up then we document it.

Regarding narcotics use, I feel that you need tho assess the effects of the narcotic individually. Is the person unsafe when the narcotic is in use? is their gate steady? Are they able to make decisions about their safety? Not eveyone reacts the same to certain narcotics. I have seen people that react very weird to codiene and do fine on other narcotics, and vise versa.

I have also seen a patient climb over the side rails because they were not able to make sound decisions. The RN who had been taking care of her put the side rrails up to prevent a fall and to prevent her from inadvertantly pulling her IV out if whe was to decide to go for a walk. This backfired and she climbed over and got hurt. In that case the prevention of injury would, in my opinion, have been more important than prevent the IV from coming out. Hindsight is 20/20 however and I cannot honestly say I would have done things any different to begin with.

Due to this patients confusion and the circumstances surrounding her admission, I would probably have put both side reails up at the time. After taht incident, I assess the pro's and con's of side rail use very carefully for each patient. If I feel that the risk of falls is high with the side rails, I will leave them down. If the person is alert and able to make sound decisons then there should be no use for the side rails anyway. Some patients request them just because they are not used to sleeping in such a small bed, and at that time I document this well. Hope this helps some.

saphie · Aug 14, 2000

Okay, this has been a topic that I have been following. Siderails are not considered a restraint where I work. It is a nursing decision to put up siderails or leave them down. One lady on the floor I work will get out of bed if the siderails are down and fall - I think on purpose but my thoughts. But makes no motion otherwise. We do have a have quite a few elderly confused patients on the medical floor I work, so siderails up and a bed alarm works well. The bed alarm goes off and the siderails prevents the pt from getting too far. On the surgical unit I work, it's a bit different, most of the patients have two side rails up not very many have all four, it's just standard practice regardless of age, diagnosis or medication.

ozbunji · Aug 14, 2000

In our hospital side rails are not considered a restraint. We use them whenever a patients safety is at risk.

Of course a patient is quite capable of getting out of bed with rails up, whether he be confused due to medications or because of an organic reason.

In this situation we will sometimes leave one rail down but make sure that the patients bed is positioned much closer to the desk and of course keep an even closer eye on the patient to ensure they are safe. We have also resorted to putting their bed on the ground but sometimes this can be bad on the backs of nursing staff and patient care assistants who have to lift heavy people from that position to attend to their ADLs