ProNurse

Glad you have got that off your chest, you have had a bad experience haven't you. Sorry you feel all the nursing staff at that establishment are incompetent, that should do wonders for their morale.

Maybe a meeting with the ward manager and discharge co-ordinator might  answer some of your concerns, particularly the safety ones.

But those are the restrictions nurses have to work under.  Bed rails can count as unlawful restraint - or deprivation of liberty - plus, unless your mother is immobile she may try and climb over them and injure or even kill herself herself in the process.  Should that happen in a care home or hospital then you might decide to call in the lawyers.

I can only guess that if you are refused bedrails then in the opinion of the MDT your mother doesn't warrant having them.  I know this doesn't always seem to make sense but dementing persons have exactly the same rights as the rest of us.  If your mother is capable of getting out of bed (without rails) then placing rails there to stop her doing that is a restraint in exactly the same way as tying her to a chair so she doesn't wander off would be a restraint.  The medical profession doesn't make these rules, lawyers and politicians do, but we do have to follow them.

I'm not sure of the legalities involved should you decide to buy a bed with rails for use at home.  I would imagine the law would be the same, however because you are doing it purely out of a desire for your mother not to get out of bed and hurt herself, you probably wouldn't get in trouble.  Professionals almost certainly could do for making that decision for those reasons.

Hospital beds have rails because some people are assessed as needing them, eg without them they may fall out of bed in their sleep.  Falling out of bed whilst asleep is an involuntary action, deciding to get up isn't, and if your mother can decide to get up then we have no right to physically stop her with rails or anything else even if (and this could rightly be seen as defying common sense, imo) she is in danger of hurting herself by doing so.

(I know Stuart knows far more about these matters than I, and if he's reading he could give a better explanation and perhaps correct me on any inaccuracies, and possibly point you in the right direction if there's anything you can do.)

Unfortunately you're really discussing this in the wrong place.  As I say, nurses, incompetent or not, don't make the laws, but we have to follow them.  I am not defending these laws either, your position seems very reasonable to me, and the law can be very inflexible as it's designed to protect the majority.  For whatever reason a decision has been made, one which you disagree with, but the only way to get it changed is challenge the MDT's decision.  Go over their heads if needs be. 

I can't speak for anywhere else, but I have never worked anywhere that rails are put up as a matter of course.  I'm an RMN and have worked EMI units and not general wards.  I don't know if your mother is in an EMI unit or general nursing.  But going by the book, rails are put up if the person has been assessed as requiring rails to be put up, and importantly, under which circumstances the rails should be up. Someone may need rails while sleeping, but not during the day and so on.  If someone dozes off during the day and is at risk of falling out of bed, then the rails should go up if assessed as needing them.  If someone is sat up in bed, awake, but cannot always support themselves, then again I'd have thought the rails should go up.  If someone is perfectly capable of getting out of bed, even if by doing so they are likely to fall, then the sides should be down.  Where I worked a resident would do just that and what we were left doing was to put crash mats by his bed so that if/when he did get out of bed and fall, he would hopefully not be hurt.  In this case rails wouldn't have mattered as he could climb over them. 

      If however rails are being put up purely to keep the person from getting out of bed, or as a matter of course, then that is a deprivation of liberty plain and simple and the hospital and staff are at risk of legal action (as far as I understand it). 

     Wheelchair restraints are for use when transferring patients or for patients who can't support themselves while sat upright.  They should never be used to stop someone getting out of the chair.  I personally have never come across a situation where they are used in this way. 

    Tables should also not be used as restraint.  I have only seen tables used because a patient has a drink or something else on the table. 

    I am not condoning bad practice.  I'm sure there are places where tables and chairs are used to keep people sat down or in bed.  But it's wrong, and it's illegal, and if I was running that ward it wouldn't happen.

MrSmirnoff says ...

Obviously a lot of double standards can be discussed here.

If it is for involuntary rolling out of bed whilst asleep then the cot sides in hospital should never be put up when the person is awake, but you will always find they are in the up position. As for chairs, is by no small coincident patients sitting out have tables put in front of them… a covert barrier to impede standing or walking away?

To me the crux has always been about measures to prevent self harm and accidents, and what might be classed as a reasonable act to prevent such events. A person that can walk, stand or climb over could indeed be claimed to be entrapped as they are otherwise attempting to escape through a barrier. Further injuries occur because of the escape being actually possible and feasible which would make such measures inappropriate heightening the potential of greaten self harm.

 

A non confused person unable to stand would get no further than the fall, but they have the right to decide and consider such events and take personal responsibility.

 

However if the person was in a mental state to imaging they can stand when in reality they can not could not be regarded as making an informed decision based on the reality of the situation. It would be an action based on primitive reflex not on cognitive and physical abilities and so in my opinion a cot side is just as much a preventative measure as rolling out of bed whilst asleep… to prevent self harm.

 

Chair restraints, an interesting issue, her wheel chair is fitted with a belt.. how do you account for that? Seat belt laws in cars, how is that able to get past the entrapment of sane individuals and minors in cars? It all comes down to what reasonable actions can be justified to prevent self and accidental harm in an environment that has the increased potential risk of injury.

Thanks for sharing.

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