Letter Re: Setting Up a Sickroom

Sir:
The author of “Setting Up a Sickroom” provided much valuable information. One tip, however, is not supported by the last 30 years of medical evidence. Side rails on a bed are known to double the incidence of falls in health care facilities, and these falls result in greater injury. The evidence is so compelling that hospital accreditation agencies will ask for corrective action, if they find indiscriminate use of bed side rails. Delirious or demented people who are intent on exiting the bed unassisted will do so, and they have more to trip them up, turn them upside down, and farther to fall with side rails. One of the most common reasons for sick people to try to get up on their own is a full bladder. Offering a means of toileting every couple of hours reduces more falls than side rails on the bed.

I am a geriatric physician (either way you interpret the term), who has studied this issue and participated in countless root-cause analyses of hospital fall incidents. Regards, – Kris

Hugh Replies: It’s important to remember that much of the research that we see regarding this kind of thing is targeted towards institutions and the problems they tend to have with staffing. Side rails can be critical in keeping a patient from rolling out of bed. However, if you have a patient that wants out of bed and no one is there to help them, they will crawl over the side rail. That’s where the accidents happen. Is the siderail really the problem? Or is it the lack of attention to the patient. Institutions, like hospitals and nursing homes, tend to run staffing on the ragged edge of what’s acceptable, and they make decisions based upon lawsuits. As a firefighter, I am appalled that we are losing access to our backboards. When we suspect neck/back injury, we board the patient for extraction and transportation. Upon arrival at the ER, we transfer custody of the patient to the ER staff. I do not want to disparage the staffing at hospitals, but if the patient is receiving damage because they spend 10 hours strapped to the backboard, is that really the fault of the EMT/fire personnel? Yet, because patients have sued over such damage, we will soon lose the ability to use backboards. Yes, statistically, the backboards do damage, but it’s because of misuse rather than proper use. Sometimes I wonder if the suits who make the decisions have ever seen (let alone participated in) removing a patient from the bottom of a 20 foot deep ravine.

As we set up our own emergency/medical stations, we should make decisions based upon sound practice, good medicine, and common sense rather than lawsuits. It’s not enough just to set up a sickroom, but we need to have procedures in place that make sure those who must utilize those facilities receive adequate care. If your patient is receiving the care they need, there should be no need for them to climb out of bed over side rails by themselves. Likewise, if you are misusing a side rail to keep a lucid patient in bed, you really need to change your procedures.

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