Re: Side rail risks vs benefits

[Debbie Ohl]

The entire issue of side rails has created a great deal of controversy, confusion, frustration and anxiety.  Let�s just simplify the problem.  The primary issue with side rail use is safety.  The key question to be answered: Is the resident safer using or not using side rails and WHY?   The primary safety concern with side rail use is entrapment (the person becomes lodged between the side rail and mattress or can put their head through the rail).  The other frequent safety hazards include skin tears, abrasions, bruising, and of course falls with fractures from attempting to climb over rails or go out the end of the bed.  These situations may be considered hazardous and create a situation of immediate jeopardy.  If you have residents experiencing any of these problems that can be linked to side rail use, immediate reassessment for continuing need is indicated.   If the determination made is that side rails are in the best interest of the person, two additional questions come up.   Does the side rail restrict movement and prevent the person from coming and going freely?  The question of ability is secondary to desire in determining if the side rail meets the definition of a restraint.  A side rail used for �Safety� to prevent the person from getting out of bed qualifies as a restraint.  The desire to get out of bed with a barrier (side rail) increases the risk for serious injury.  The side rail is not protecting the person under these circumstances.   If the answer to this question is yes, you must follow the guidelines for physical restraints.  These guidelines demand medical necessity for use and expand the assessment and care planning needed.  Medical necessity may include things such as active seizures, constant restlessness and thrashing, etc.  If used for medical need you must actively evaluate and plan for prevention of risk factors from materializing.  Failure to do so breaches the standards of practice.   Is the side rail enabling the resident to move about in bed?  If half rails are used, typically the rail is not acting as a restraint, because the person can still get in and out of bed.  Then you are back to the original question.  Is there a safety risk to the resident?  If so what interventions will you put in place to safeguard the individual?  Of course if they view the half rail as keeping them in bed it does not qualify as a restraint.  Three quarters of full rails are not necessary if rails are being used to enable bed mobility.  If this is all that the facility has available, the facility has a problem, not a resident need.   Debbie Ohl RN, NHA LTC Consultant & Educator, Ohl & Associates 613 Compton Road, Cincinnati, Ohio 45231 Phone / Fax 513-522-6041 [EMAIL PROTECTED]  www.greatcareplans.com ----- Original Message ----- From: Tracy Howard To: [EMAIL PROTECTED] Sent: Tuesday, March 30, 2004 8:31 AM Subject: Side rail risks vs benefits We had state survey here last week and they kept asking us for a risk versus benefit assessment on the side rail assessments that we had coded enablers.   We did not get any deficiencies regarding side rails, but I don�t want this question to come up again with other surveys.   Does anyone have a risk versus benefit assessment they would be willing to share?                                      Tracy Howard, RN BSN

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