What is the standard of practice regarding side rails on stretchers; fall risk

[Shubbell]

In an ambulatory surgery center we use stretchers for pre-op and post-op patients. We all know the general policies for side rails in hospital beds, that is there are 4. Two top ones must be up but all 4 is considered a restraint. How does that work for stretchers when not in transport? There are only two rails and when both up, the patient would have a very difficult time getting out of the stretcher. Putting them down from the inside is nearly impossible and the only other way is for the patient to scoot all the way down to the end. Could it be argued that with a totally alert and oriented patient, having both rails up with the intention of making them call you for assistance, could be considered using those rails as a restraint? I've seen both rails up or one rail up. I agree that it's likely never appropriate to have both down because stretchers are generally narrow, but if a patient falls and only one rail was down, do you say it was because that one rail was down? Stretchers are confining and often patients don't want both up and as long as I can assess that they are alert and fully oriented, is it then ok to leave one down? Our hospital doesn't seem to have a policy specific to stretcher rails and I'm curious what you guys think. I feel like transport is the only black and white answer as far as patient safety regarding these rails. Obviously during transport hot must be up. What about the ER or an ambulatory surgery setting?

[bugya90, ASN, BSN, LVN, RN]

Not all hospitals consider all 4 rails restraints. My current hospital doesn't but the hospital on the other side of town does. We put the side rails up on stretchers and honestly I've never given that much thought. The stretcher is going to be high so whoever is pushing it doesn't have to bend down so it could be argued that the side rails are for safety because of the stretcher height.

[Guest219794]

I work in an ER. If I think somebody might fall out of bed, and the rails might prevent that, I put them up, as I would prefer that my patients don't fall.

Not sure what the policy is, and haven't asked.

[MunoRN, RN]

From CMS regulations:

Recovery from anesthesia that occurs when the patient is in a critical care or postanesthesia care unit is considered part of the surgical procedure; therefore, medically necessary restraint use in this setting would not need to meet the requirements of the regulation. However, if the intervention is maintained when the patient is transferred to another unit, or recovers from the effects of the anesthesia (whichever occurs first), a restraint order would be necessary and the requirements of standard (e) would apply.

https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/downloads/R37SOMA.pdf

[canoehead, BSN, RN]

I ask if the patient prefers them up or down, and phrase it so they say "up." Just verbally worry that they might fall out because the stretcher is thinner than their bed at home.