Side Rails & Restraint - The Final Word
By: Richard Curtis RN, MS, HACP
It's not a question as old as time, but it's been asked so often that it might as well be: "Are side rails considered restraint?" As you might expect, the answer is both yes and no.
The first step is to understand what triggers looking at the use of side rails as possible restraint. The answer is deceptively simple. It's the number of rails in the raised position! If all four side rails on a bed are in the raised position, it may constitute restraint. If even one of the four rails is maintained in the lowered position, then such use would generally not constitute restraint.
For the sake of this discussion, let's say that all four side rails have been placed in the raised position on a patient while in bed. The next step then is to determine why the side rails are up. If the rails are up to keep the patient from falling out of bed, it would not be considered restraint. Examples proffered by CMS include the following:
- Raised side rails on beds that constantly move to improve circulation or prevents skin breakdown, are a safety intervention to prevent the patient from falling out of bed and are not viewed as restraint.
- When a patient is placed on seizure precautions and all side rails are raised, the use of side rails would not be considered restraint. The use of padded side rails in this situation should protect the patient from harm, including falling out of bed should the patient have a seizure.
- Placement in a crib with raised rails is an age-appropriate standard safety practice for every infant or toddler. Therefore, placement of an infant or toddler in the crib with raised rails would not be considered restraint.
- If a patient is on a stretcher (a narrow, elevated, and highly mobile cart used to transport patients and to evaluate or treat patients), there is an increased risk of falling from a stretcher without raised side rails due to its narrow width and mobility. In addition, because stretchers are elevated platforms, the risk of patient injury due to a fall is significant. Therefore, the use of raised side rails on stretchers is not considered restraint but a prudent safety intervention.
However, if side rails are placed in the raised position to keep a patient from getting out of bed, then that would be limiting the patient's mobility and hence considered restraint.
The use of side rails is inherently risky, particularly if the patient is elderly or disoriented. The risk presented by side rail use should be weighed against the risk presented by the patient's behavior as ascertained through individualized assessment.
So... that's the answer to the side rail question. Now on to the most debated question of all time... "What came first, the chicken or the egg?"
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