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Hospital Accreditation

Side Rails & Restraint - The Final Word
Posted by
on 12/10/2019 10:00:00 AM
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:
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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About the Author

Traci Curtis RCP, HACP
RCP, HACP

Traci Curtis is the Executive Director of Survey Operations for CIHQ. Traci has more than 15 years of experience in hospital survey preparation.
Traci's past positions include Chief Quality Officer for a multi-hospital community based health system where she was responsible for accreditation and regulatory compliance. Prior to joining CIHQ, Traci served as the Executive Director of Quality for a large regional medical center, providing executive management oversight in the areas of quality, risk, medical staff credentialing, and patient relations.
Traci received her degree in education from Pima in Tucson Arizona. She is nationally certified in healthcare accreditation, and serves on the Board of Examiners for the Healthcare Accreditation Certification Program.
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