Re: QUESTION ON SIDE RAIL CODING

[Ted Anderson]

Working at a facility that had the electric Hillrom beds with the bed controls built in to the quarter side rail, many nurses thought they were "assistive devices" and did not see a problem/dangers with them. Then we recieved 2 K's (yes there is such a thing, got to love Washington State!) at our annual survey.   Each resident needs to be thoroughly assessed for ability to use the side rail (does the demented client know how to use the rail as a bed mobility device or understand how to use the buttons on the bed control?) They must be able to demonstrate the ability to use them and it must be documented. They also need to be assessed for involuntary movements, risk of injuring themselves on the bed rail, fall risk, etc...   The side rails must not have an gaps in which a resident can entrap themselves in it (I heard from a State Nurse that 5 resident's in LTC were strangled by side rails last year).   I also caution the use of most transfer or assistive devices on the market today. They are more dangerous than the side rail.   So "they" want to do away with all the side rails...SNF's are actually ahead of the game on this as I spoken with some nurses in the hospitals that are in the preliminary phases of what we have been doing for quite some time. At my facility we are currently looking into alternatives that are safe and will enable our residents. Low Beds, Air Mattresses, Fall EZ Mats, Transfer/Mobility Aides, Safety Alarms...all need to be incorporated into an individualized assessment and reassessed frequently. I would be more than happy to discuss this with anybody individually on how to tailor a program to get there.   Areas on the MDS that need to be looked at though:   G1a: Bed Mobility: This is the preverbial Catch 22. The resident that we coded as a 2 or 3 for bed mobility with the use of the side rail are now possibly a 4 without one. We are currently researching how to remedy this. Loss of function....yikes.   G6b: Bed rails used for bed mobility and transfer. This needs to be assessed for actual ability and documented.   P4a/b: Per the RAI manual, if it is on the bed and used at any time during the last 7 days, day or night, and the resident cannot "remove easily" it's coded as a restraint. Worth noting, this includes a bed against the wall is considered a full bed rail.   Hope this helps you guys out, I drop me a line if you have any questions or suggestions, luckily none of our resident's were injuried while we had the quarter side rails on, the 2 K's made us a little more aware on how to make our resident's safe and hopefully maintain their highest level of functioning.   Ted Anderson RN, MDS Coordinator The Hearthstone [EMAIL PROTECTED]         ----- Original Message ----- From: Debbie Davis To: [EMAIL PROTECTED] Sent: Wednesday, May 05, 2004 7:51 AM Subject: RE: QUESTION ON SIDE RAIL CODING we always code 2 rails in use but NOT as restraints - our bed controls are on them (built in) and most use the rails to turn in bed so they are assistive devices -----Original Message----- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED]On Behalf Of [EMAIL PROTECTED] Sent: Tuesday, May 04, 2004 4:31 PM To: [EMAIL PROTECTED] Subject: QUESTION ON SIDE RAIL CODING Hi Everyone I am looking for an answer quickly since the state surveyors are in the building.  If side rails are required on a specialty bed (full rails times 2) but are not used as a restraint do you code this on the MDS under section P for device/restraints.   Thank You   CONFIDENTIALITY NOTICE:         This message is intended for the use of the individual or entity to which it is addressed and may contain information that is privileged, confidential and exempt from disclosure under applicable law. If the reader of this message is not the intended recipient or the employee or agent responsible for delivering this message to the intended recipient, you are hereby notified that any dissemination, distribution or copying of this communication is strictly prohibited.         If you have received this communication in error, please notify us immediately by email reply or by telephone and immediately delete this message and any attachments. Call us at (217) 464-2864.