3 or 4 siderails?

This is just a "poll" or "interview" kind of question. I wanted to get some opinions from others.

For this scenario, please assume that the bed has 4 siderails. At this facility, all 4 rails up is NOT a restraint.

***Patient 'Ethel' is an ambulatory lady, high risk for falls.

When you put her to bed, how many rails do you put up? Why?

I choose to put only 3 up because I think she could get hurt worse by trying to climb over all of them.
3...for the reason you stated. If someone tries to get up, they can get hurt worse with 4 up. I would put 3 up, call light within reach, keep area free of clutter, use "hip huggers", mats next to bed, non-skid footwear, bed alarm, low boy bed...

Quote from wish_me_luck3...for the reason you stated. If someone tries to get up, they can get hurt worse with 4 up. I would put 3 up, call light within reach, keep area free of clutter, use "hip huggers", mats next to bed, non-skid footwear, bed alarm, low boy bed...

I would NOT use a mat on the floor. If "Ethel" is ambulatory- they are more of a trip hazard than anything. I would personally put up 2 rails and use a tab alarm/ bed alarm.

Yes, those mats are really for "rollers", not ambulatory fall risks. They are also a fall risk for staff.

I'd say no rails if she is at risk of standing up in the bed and climbing over them ie falling from a greater height, increased risk of injury. Have you got low low beds that go all the way to the floor? By putting the pt on one of these beds it is harder for them to get their knees "underneath" them and to stand up. As long as the bedside table and chair are removed from the area so she cannot use them as a lever. Is her sleep pattern good? Is she awake and stimulated and exercised during the day to wear her out?I hate being on nights with a confused pt who has slept all day and now is awake all night and trying to fall!

Quote from morteYes, those mats are really for "rollers", not ambulatory fall risks. They are also a fall risk for staff.

We only have 2 rails on our beds so for any pt that has a history of escaping at night we put a posey on them

Quote from MessyMommaAt this facility, all 4 rails up is NOT a restraint.

Hip huggers are these padded "garments", for lack of better terms, that fit around the hips to help prevent hip fractures if there is a patient that just will not stay in bed and decides to get up and falls. Also known as Poseys...heard of those?The mats...when I teched, they were used for rollers and for those at risk for falls (that would not stay in bed), and yes, I agree, I myself, have tripped on them. If worse came to worse and they were confused, getting up, etc. and we did all those things and moved them closer to nurses station and it still didn't work...we put a sitter in the room...insurance won't pay for that though, that's why it was last resort.

Quote from psu_213What gives this facility the "right" to say that 4 rails up is not a restraint? Sorry to get off topic, but I was just curious as to how a facility can deem that not be a restraint.I would even consider 2 rails. Suppose 3 are up and Ethel tries to get OOB on the side with 2 rails up and gets stuck between the two rails...not pretty.

I would put up 3. At my facility 4 side rails is considered a restraint, although I do sometimes see it. Along with side rails: bed alarm, low bed (all low beds have mat where I am) and maybe a lap belt. Depends how they are once up.