Siderails in LTC

[jones58]

In the facility where I work we have been slowly eliminating siderails. State guidelines say that siderails are a restraint, also there is a risk of being entangled in rails. So we are replacing SR's with different interventions. Some patients have very low to the floor beds, and we are also using bed alarms, concave mattresses, and posey rolls, also landing pads in case all other measures fail.

If the facility that you work in is also doing this, what do you think of it? We had two people fall out of bed last weekend. The care plan for those two pts. was being followed, but it seems that the system that is suppose to protect them failed.

[Rustyhammer]

No longer can you restrain a resident for no apparent reason. LTC regs now state that you must use the least restrictive device and have all other alternatives tried documented. Low beds, "scoop" mattresses and half rails are all alternatives among others.

Alarms can be considered a restraint if the resident is put back to bed and isn't allowed to get up.

Other restraints = lap buddies (cusions across the w/c) tray tables,geri-chairs if it prohibits rising, seat belts and others.

-Russell

[jones58]

Our low beds have remote controls to raise/lower the height of the bed. A month or so ago, one of our pts got hold of the remote and while in bed raised the bed to the highest position, probably shoulder height. No harm done. He was found sitting on edge of bed with a big smile, swinging his legs. Way up there. All documented and remote tucked away where he could not find it anymore.

But can you imagine what might have happened?

[sandyth]

We use full srs, low beds, tabs monitors, mats on floor for protection, wedges between rails. you name it we use it. Pt safety is goal # 1.

[huganurse524]

That is actually something I just found out during orientation at an acute care facility. In LTC side rails are a form of restraint but not at the acute care facility or hospital so they are used without consent.

[caffine addict]

Jones 58

Back to your original message. What did the care plan say? That the resident would be free from falls? Or the resident would be free from injury? If they fell and had no injury then you were sucessfull. After all you expect that they will try to get up and fall thats why you use the floor mats. Anyhow, everyone else is right nothing is going to stop a confused resident. Sometimes the low beds are not the correct solution. The harder we make it for them to get up the harder they fall. If the bed is the proper height for a safe transfer and the resident gets PT or restorative ambulation for gait and balance training they may be at a lesser risk for falls.

[slinkeecat]

We use siderails in this LTC facility that I work parttime. We did have to justify them so we had write lame orders like

SIDE RAILS x2 to aid patient in mobility in bed

then we have to document:

Pt utilizing side rails to turn over in bed during incontinence care.

Well, Well, Well...

We have bed alarms, but the pt's I have are clever and can shuck them off in the blink of an eye.....

My most unhappy experience was with a pt who had side rails and they were padded with these gym mat like padding and some how she managed to get pinned between it and the rail and she suffocated. It was a very horrifying accident. I hate those pads... It was awful.

[jjjoy, LPN]

Sometimes the solution is more dangerous than the problem!

How about nurses spending less time documenting rational for every last tissue handed out, less time constantly readjusting everything to ensure that one kind of accident "never" happens again (e.g. falls), and had more time to spend with the patients - to recognize agitation before it gets to a crises point, to have time to transfer a restless pt from their bed to a wheelchair in the community room, etc... Sigh, I can wish...

[jones58]

Its been over a year since my original post. Both of the pts I referred to have expired (not related to a fall out of bed)! We're having good luck with our reduced siderail programs, but not very good luck with our reduced staff programs. Its very difficult to answer 2 bed alarms at the same time. How do you decide which pts are getting out of bed and which ones are turning over? We have the bed alarms that are a strip that goes under the mattress and sensitive to the pts movement. I honestly think some of our alarms are so sensitive they are triggered by flatulence.

[ktwlpn, LPN]

Originally posted by greer128

So far it is wroking ok, I still believe that a few res, need restraints though, because nothing else seems to work.

The measures that I find most effective is to put the resident to bed only when they are clearly good and ready to go-after toileting,a snack and a drink and maybe extra strength tylenol has been given.At the first sign of restlessness we get them up and repeat the above-and sit them in our sitting area in front of the nurse's station until they appear to be ready to go back to bed again...and document.Nothing worse then sending a resident to the er for evaluation of lethargy when they were awake all night and you were not told during report....Staff must remeber that sleep disturbances often go hand in hand with dementias...

+

[nurse62]

We have used all the techniques as well. Low bed, half side rails, alarms, etc. Full side rails x2 as an enabler is a restraint. However if patient is unable to reposition themselves in bed to prevent a possible fall, we use full side rails x2 as a safety measure. However, if we use the side rails and the patient is climbing out of bed, the siderails then become more harmful than not having them at all due to the distance of the fall would be greater. Thus, we reform to a low bed, alarms, etc. Most importantly, if a patient is climbing out of bed. Get them up. Toilet, feed, walk, etc....so they don't fall. Easier said than done, I know.

[LPN216]

First of all.....SNF stands for "Skilled Nursing Facility". Or the skilled unit withing a Long Term Care Facility. This is the unit that is utilized for post hospitialization pts, or those expected to be shorter term stays. Once discharged, they can go home, to another facility, or be placed on a long term wing or unit within the current facility.

Second.....if you have someone you just dont feel comfortable leaving without a siderail.......care plan it as "an enabler". This will allow you to leave the 1/2 siderail up, and the patient or resident can use it for balance, helping to turn, or helping to pull themselves up to a sitting position. Many times the reason for a fall is that the person is trying to reach for the nightstand to hold onto, or worse yet, they reach for the overbed table (with wheels), and lose their balance.

Just a thought.

[STM]

Originally posted by shygirl

We cannot put the beds against the wall, that is considered a restraint. we have siderails only if it's documented that patient has fallen out of bed or gets up unassisted. We use monitors that beep, low beds too

Shygirl

At our SNF we have hall monitors on occasion who do nothing but walk the halls, checking rooms and brakes and rails, and patient safety. Which still isn't enough sometimes. We also have bed alarms, w/c alarms, low beds, half rails, and if the supervisor feels restraint is needed, as in rails, they can write an order for it for a 24 hour period. That helps get us through the night...sometimes. But falls are going to happen. No matter what you do, some are going to fall regardless...or have a skin tear, etc. Even with the bed alarms, sometimes you just can't get there quickly enough as it is.