4th Side rail as restraint

[Celia M, ASN, RN]

Hi Guys, I need your help, we are having a tough time complying with JCAHO and getting orders and completing documentation when we have 4 side rails up. Do any of you have ant ideas that have worked for you?

Thanks Celia:wink2: :wink2:

[catlady, BSN, RN]

Well, first of all, why DO you have four side rails up? They are very dangerous. If someone is that much at risk for fall, they're going to climb over them, through them, around them, and out the end of the bed. You need to come up with a better plan for protecting your patients.

As far as documentation, how do you order and document your other restraints? There shouldn't be any big difference.

[lsyorke, RN]

Yup, 4th rail is a restraint, and restraint documentation must be done!

[GatorRN]

We used the same documentation for any type of restraint, be it soft restraints, hard restraints, or side rails. What do you use now for restraint documentation? The same thing should be applicable.

We used a flow sheet that covered a 24 hr time frame. It was columned off where the nurse would initial when completing the specified requirement. It was initialed hrly, Q 2hrs, Q 4hrs, etc... based on what was done such as, removed/replaced for circulation ck, repositioning, offer toileting, or what ever the case may be.

[husker-nurse, LPN, LVN]

In our facility, as long as a PATIENT or FAMILY MEMBER requests that the 4th siderail be up, it's not considered a restraint. HOWEVER, I always chart "SR up x4 per patient (or family member, with name, if possible). The name of the game is, after all, CYA.

[CoffeeRTC, BSN, RN]

In LTC any siderail is considered a restraint. If a pt cannot lower it themselves..... We use low beds, mats on floor, concave mattresses, booster rolls on the side of the bed....very creative.

I know I liked my top two siderails up when I was in the hosp with my babies.

oh...we sometimes add on the order...SR up per res request for increase sense of safey, assist with repositioning to aid in res independance. That used to work for us.

[Otessa, BSN, RN]

4 siderails up are equivalent to wrist restraints...........

[husker-nurse, LPN, LVN]

4 siderails up are equivalent to wrist restraints...........

Otessa, it depends on your facility; in mine, it is NOT considered a restraint if family or patient requests it.

[Antikigirl, ASN, RN]

Where I am working now, hospital, this is not considered a restraint if the patient asks for it, and I document that!

In the ALF I worked in...whole different story! Oh man it was so darned complicated it wasn't funny! What would occur is, during the three month evaluation and service plan meeting...all the members of the family and a rep from all nursing/admin staff had to bring up a plan of action on things to use before the use of the siderails. Then for three months we had to try all these other things and document how it was going daily on an interium service plan.

Then after the three months of other tactics (lowering beds, pads on the ground, body pillows, etc) if we could prove that the bedrails were needed and wanted by the patient, then we had to obtain an 90 day order from their physician, and go over all the plans and discuss it with the family at the next service plan meeting (Family and MD's just loveeeeeed this..UHG!). Then the request was submitted to some department I don't know about in the State, and either approved or not dependant on the three month trial period.

After that, if the rails were authorized...this was always re-discussed and MD order obtained every three months with the resident service plan meetings and re-submitted.

It was a pain, and really made me fairly upset when I had residents that were told they HAD to have a hospital bed at our facility, and they we not able to choose to use them or not (I mean residents that weren't at risk of falls and alert and moble enough for them). I had residents that wanted them so they didn't roll out of bed or felt more secure...and even that choice was taken...even though it was THEIR bed! (for people at risk I understand...but oriented mobile people with no risk???).

Anywhoo..that is what we did to comply with our state policies, and quite a pain actually when it comes down to it. Family and MD's typically find this wayyyyyyyy to much to deal with for just a bed rail (and at times I didn't blame them) and simply got mad at us nurses who didn't have a choice but to go through the motions....

Glad I don't have to go through all that now...I will use siderails if a patient wants it, and not if I find a pt at risk (we have a fall risk/mobility risk/skin risk assessment done at admit and know if rails are a good thing or bad).

[purplemania, BSN, RN]

We consider the 4th rail a restraint unless requested by patient (not family) or if pt is in transport. We document accordingly. Remember, a lot of the issue has to do with your intent. If the rail is up because you intend it to keep the patient in the bed and prevent a fall, or make it convenient for you, then it is a restraint. Same with Geri chairs. If a patient requests the fixed tray in front so they can play cards or whatever, then it is not a restraint. If you secure the tray to keep them in the chair, it is a restraint. Intent matters and the only way to know intent is to DOCUMENT.

[caba35]

Where I'm at, top side rails are simply not used except in well documented restraint situations

[mandana]

I agree with purplemania, intent has a lot to do with it.

In my facility, if the patient is cognitively intact and agrees to rails x4 as a reminder to call for assistance ambulating, it is not a restraint. BUT, you better make sure that the patient is alert and aware and agrees to it - and of course, you should document to that effect.

If the patient cannot reliably give consent, it's a restraint.

Amanda