April Q&A: When are bed side rails a safety device and when are they a restraint?

Q: When are bed side rails a safety device and when are they a restraint? -- Betty Holman, RN

A: The number or type of side rails (i.e., use of four half rails, three-quarter rails, or full-length rails) does not determine whether side rails are safety devices or restraints. It is the patient’s activity in relationship to side rails that is the determining factor. Side rails are a restraint if they restrict or impede a patient’s independent transfers from bed. Also, side rails can increase the risk of falls and injury. Many patients, especially those individuals who are cognitively impaired, tend to go over or around side rails when exiting the bed. On the other hand, simply removing side rails without addressing the patients underlying problems can be equally dangerous. This can result in increased falls (even injurious falls). To maintain patient safety, a half-side rail to assist or enable patients with bed positioning or balance stability during bed transfers can be used. Keeping bed heights low to the floor or using low platform beds helps to guard against injurious falls. In addition, some recommend the use of fall alarms to alert staff when mobility-impaired patients are exiting their bed.

I hope that this information has been helpful. Thank you for the question.

Dr. Rein Tideiksaar