Safety & Support: How is a side rail used when there is a patient client on bed?

Did you know that hundreds of thousands of patients fall from beds annually, with many resulting in injury? Understanding how is a side rail used when there is a patient client on bed is a critical first step in preventing these accidents and ensuring safety.

Quick Summary

A bed side rail is used to prevent falls for sedated or disoriented patients, provide a hand-hold for repositioning, and offer a sense of security. Proper use depends on a careful patient assessment.

Key Points

• Patient Assessment is First: Always evaluate a patient's physical and cognitive status before deciding to use a side rail.

• Prevent Falls & Aid Mobility: The dual purpose of side rails is to prevent accidental falls and to provide a stable hand-hold for patients to reposition themselves.

• Entrapment is a Serious Risk: Ensure there are no dangerous gaps between the rail and the mattress or bed frame where a patient could get trapped.

• Partial Rails are Often Safer: Half or quarter-length rails often provide necessary protection without creating a sense of confinement or encouraging climbing.

• Use in Combination with Other Measures: The safest approach combines side rail use with other interventions like keeping the bed in the lowest position and using bed alarms.

• Regular Maintenance is Crucial: Always check that side rails are properly installed and the locking mechanisms are secure before use.

The Core Functions of Bed Side Rails in Patient Care

Bed side rails are a common feature on hospital beds and home care beds, but their purpose is often misunderstood. They are not restraints but rather safety and mobility aids. When used correctly, they serve several crucial functions. The primary goal is to enhance patient safety without compromising their freedom of movement or causing unintended harm. Understanding how is a side rail used when there is a patient client on bed involves balancing the benefits against the potential risks.

Primary Uses and Benefits

1. Fall Prevention: For patients who are restless, disoriented, or under the effects of medication, side rails can provide a physical barrier that prevents them from accidentally rolling or falling out of bed. This is especially critical during the night or when the patient is unattended.
2. Patient Mobility and Repositioning: For many patients, a side rail is an essential tool for independence. They can use the rail to grip onto, helping them to turn, sit up, or adjust their position in bed. This simple assistance can empower patients and reduce the physical strain on caregivers.
3. Support for In-Bed Activities: Side rails can help a patient feel more stable and secure when eating, reading, or performing other activities while sitting up in bed.
4. Psychological Comfort: For some individuals, the presence of a raised rail provides a sense of security and a defined boundary, which can reduce anxiety about falling.

A Step-by-Step Guide to Proper Side Rail Use

Improper use of side rails can lead to serious injury, including entrapment. Following a systematic process is essential for ensuring patient safety. This process should always begin with a thorough individual assessment.

1. Conduct a Comprehensive Patient Assessment

Before using a side rail, a healthcare professional or trained caregiver must assess the patient’s specific needs. Consider:

• Cognitive Status: Is the patient alert and oriented? Or are they confused, agitated, or prone to climbing?
• Physical Ability: Can the patient reposition themselves? Do they have the strength to use the rail for assistance?
• Fall History: Has the patient fallen before? What were the circumstances?
• Patient Preference: If the patient is able, discuss the use of side rails with them. Do they feel safer with them up or down?

2. Select the Correct Type of Side Rail

Not all side rails are the same. They come in various lengths (full, three-quarter, half, quarter) and designs. The choice depends on the assessment.

• Full-Length Rails: These are often considered restraints and increase the risk of a patient trying to climb over them, potentially leading to a more severe fall. Their use is highly restricted in many facilities.
• Half or Quarter-Length Rails: These are generally preferred. They can be positioned to prevent rolling out of bed while still leaving ample space at the foot of the bed for the patient to exit safely, reducing feelings of confinement and the risk of climbing.

3. Ensure Proper Installation and Maintenance

• Check for Gaps: Before the patient uses the bed, ensure the rails are installed correctly per the manufacturer's instructions. There should be no dangerous gaps between the rail and the mattress or between the headboard/footboard and the rail where a patient's head, neck, or body could become trapped.
• Regular Inspection: Regularly check that the rails are secure and that the locking mechanisms function correctly. Worn or damaged equipment should be replaced immediately.

4. Implement Safe Usage Protocols

• Upper Rails Only: Often, raising only the rails near the head of the bed provides sufficient support for repositioning and a barrier against rolling out, while leaving the area near the foot of the bed open for safe entry and exit.
• Lowest Bed Position: The bed should always be kept in its lowest position when the patient is resting. This minimizes the distance to the floor and reduces the severity of injury if a fall does occur.
• Use of Bed Alarms: For high-risk patients, a bed alarm that sounds when the patient attempts to get up can be a more effective and less restrictive alternative or supplement to side rails.

Comparing Side Rail Types: Risks and Benefits

Choosing the right side rail involves a trade-off between safety and freedom. A comparison can help in making an informed decision for the patient.

Rail Type	Primary Benefit	Primary Risk	Best For...
Full-Length	Maximum enclosure for preventing falls from rolling.	High risk of entrapment or patient climbing over, leading to more severe falls.	Highly restricted use; typically for sedated patients under direct supervision.
Half/Split Rails	Provides protection for the torso and head while allowing a clear exit path.	Moderate risk of entrapment if gaps are not properly managed.	Patients who need help repositioning and some fall protection.
Quarter-Length	Excellent as a hand-hold for mobility and repositioning.	Minimal protection against falling out of bed.	Alert, mobile patients who need an assistive handle to get in and out of bed.
No Rails	Maximizes patient freedom and eliminates entrapment risk.	Highest risk of accidental falls for at-risk patients.	Patients who are fully alert, stable, and assessed as low fall risk.

Risks Associated with Bed Side Rails

While they can be beneficial, it's crucial to acknowledge the risks. The U.S. Food and Drug Administration (FDA) has issued warnings about potential hazards. According to the FDA's guidance on bed safety, caregivers must be aware of these risks.

Key Risks Include:

• Entrapment: Patients can get caught in the gaps between the rails and the mattress. The most dangerous zones are between the bars of the rail, between the rail and the mattress, and between the rail and the headboard or footboard. This can lead to serious injury or asphyxiation.
• Falls from Climbing: Agitated or confused patients may try to climb over the rails. A fall from this greater height can be far more dangerous than simply rolling out of bed from a low position.
• Injuries: Bruising, skin tears, and other injuries can occur from hitting against the rails.
• Restriction of Freedom: The feeling of being physically enclosed can cause agitation, anxiety, and a sense of isolation in some patients.

Conclusion: A Tool, Not a Cure-All

So, how is a side rail used when there is a patient client on bed? It is used with careful consideration, constant reassessment, and a deep respect for the patient's dignity and safety. It is not a default solution but a clinical tool to be applied based on individual needs. The ultimate goal is to create the safest possible environment, which may involve using partial rails, bed alarms, lowering the bed, or using floor mats. By prioritizing a patient-centered approach, caregivers can effectively use side rails to enhance safety and promote mobility, rather than creating unintended hazards.

Frequently Asked Questions

Are bed side rails considered a restraint?

Sometimes. If a side rail (especially a full-length one) is used to prevent a patient from voluntarily getting out of bed, it can be considered a physical restraint. However, if it's used to assist with mobility or prevent accidental rolling, it's considered a safety device. The intent and the patient's condition are key factors.

What is the biggest danger associated with bed rails?

The most serious danger is entrapment, where a patient's head, neck, or chest gets caught in the gaps of the rail or between the rail and the mattress, which can lead to severe injury or death. Falls from climbing over a rail are also a significant risk.

How do I know if a patient needs a side rail?

A thorough assessment is required. Consider their fall risk, medical conditions, cognitive state, and mobility. If they are prone to rolling, are disoriented, or need a handle to help them move, a rail might be appropriate. The decision should be documented in their care plan.

Are there alternatives to using side rails?

Yes. Effective alternatives include lowering the bed to the floor, placing mats on the floor next to the bed, using bed alarms that alert caregivers when a patient tries to get up, and providing a trapeze bar for mobility assistance.

Can a family request that side rails always be kept up?

A family can make a request, but the clinical team or facility has the final say based on a safety assessment. If the team determines that raised rails pose a greater risk to the patient (e.g., risk of climbing), they may recommend alternatives even if the family prefers the rails up.

Which type of side rail is safest?

There is no single 'safest' type for everyone. However, half-length or quarter-length (assist) rails are generally considered to have a better safety profile than full-length rails because they reduce the risk of entrapment and climbing while still providing mobility support.

How often should bed rails be checked?

Bed rails and their attachments should be checked regularly as part of a routine maintenance schedule. They should also be inspected every time a patient is admitted to the bed to ensure they are secure and there are no unsafe gaps.