Urgent question about policy for bedrails as restraints in ICF DD facility

Editorial Team / Admin · Jun 11, 2009

Moved to General Nursing Discussion.

pennyaline · Jun 11, 2009

I'm a training Personal Support Worker which is a Certified Nursing Assistant in Canada. My question is about stateside policies on bed rails and geri chairs that have been requested by family as a means of guaranteeing safety and security to the client.
If a facility has removed those contracted items, saying they are unnecessary restraints, and they are allowing patients to fall, what can be done?
A quick response is very desireable.

Those items ARE restraints and cannot be implemented simply because families want them.

The facility is not ALLOWING patients to fall by removing side rails and geri chairs from routine use.

Restraint use NEVER guaranteed safety and security for patients, and indeed frequently presented a higher risk for pressure ulcers, increased incontinence, total loss of mobility, social isolation, depression, falls resulting in severe injuries, and serious restraint-related injuries including fatalities.

If you look carefully at how things are done in your facility, I think you'll find that other measures to prevent falls and minimize fall-related injuries are in place.

Flare, ASN, BSN · Jun 11, 2009

I tend to disagree. Side rails and geri chairs should not be put into the same column as wrist restraints and posey vests. Both are non binding safety devices designed to prevent falls. I think that removing them can be a just legal argument for someone if their loved one suffers a fall.

On my unit the policy was that side rails needed to be up unless a specific patient request was made - which was then documented.

I am not sure what type of facility you are referring to - intermediate care facility for developmentally disabled?? I would say that those type of residents would need to have safety devices in place to prevent injury and if they don't that a family request for that is not asking too much.

pennyaline · Jun 11, 2009

I tend to disagree. Side rails and geri chairs should not be put into the same column as wrist restraints and posey vests. Both are non binding safety devices designed to prevent falls. I think that removing them can be a just legal argument for someone if their loved one suffers a fall.
On my unit the policy was that side rails needed to be up unless a specific patient request was made - which was then documented.

What kind of facility was yours? How long ago?

I am not sure what type of facility you are referring to - intermediate care facility for developmentally disabled?? I would say that those type of residents would need to have safety devices in place to prevent injury and if they don't that a family request for that is not asking too much.

State and federal regulations consider any device that prevents mobility to be a restraint. Side rails are obviously restraining. Geri chairs are restraints because they prevent or impede the user from rising to a standing position.

ICF/DDs are long term care facilities and operate under the same regulations as any other LTCF, and have to follow the same rigid restraint and restraint-alternative protocols.

It's hard to believe that, nearly two decades after restraint reduction regs were implemented, the logic behind avoiding restraints remains so elusive to health care workers.

arckangel6983 · Jun 24, 2009

I apologize for the confusion. This post was originally made in a separate thread but moved to its own by a moderator. The title was never changed... the situation applies to a LTCF, with a person with dementia resulting from ABI. their family had requested Side rails and geri chairs for the safety of the client, and the facility removed that despite having had a document signed with the family. the original document states clearly that rails and geri chair are to be used because the person is at risk for falls and is a paraplegic(full paralysis on legs, and partial use of arms) with contracture of the hands. It's important to note that the person on the original signing contract has the POA over the individual.