SIDE RAILS REALLY DO KILL!
It happens all too frequently...patients die when they became entangled in side rails. Unfortunately, hospitals have only recently begun the siderail reduction programs that have been the norm in nursing homes for years. It is also unfortunate, that there is still considerable resistance to side rail reduction in some long term care facilities. For a comprehensive explanation of the history of siderail usage, how they have become part of nursing practice, and the current view of them as dangerous restraints whose use must either be minimized or carefully managed, go to: http://connection.lww.com/Products/macnee/documents/AppendixC.pdf
For detailed technical information on the risk of siderails, see the FDA Bulletin on the subject that was issued in 1995. It is interesting to note that while this early advisory outlines the dangers of siderails, it focuses on mechanical inspection and use of other restraints with siderails as the remedy, instead of the now promoted efforts at riderail reduction or elimination.
Making clinical decisions to use or reduce siderails can be very challenging. This task may be made even more difficult by family members or designated representatives who insist on rails being used. Very often, facility staff give in to such requests without clinical justification. It may be helpful to consider this problem in a different context. If a family member or designated representative insisted on a resident being placed on insulin when the resident is not a diabetic, no clinical team would agree to such a request. Likewise, if there is no clinical indication for siderail use, the team would be negligent to engage them. The federal regulations are clear that in the absence of clinical need, neither family request nor physician order for such restraints would be considered valid. A resource that may be helpful in determining the necessity for side rails or to facilitate their reduction may be found at http://cms.hhs.gov/cop/2e.pdf .