I have also seen a patient climb over the side rails because they were not able to make sound decisions. I have seen people that react very weird to codiene and do fine on other narcotics, and vise versa. Is the person unsafe when the narcotic is in use? is their gate steady? Are they able to make decisions about their safety? Not eveyone reacts the same to certain narcotics. Regarding narcotics use, I feel that you need tho assess the effects of the narcotic individually. If the patient requests the side rails up then we document it. Our policy is to have at least one side rail down for the patient unless the patient is having seizure precaustions, ect. We consider side rails a restraint if the patient could otherwise get out of bed on their own. With the adoption of a falls risk assessment program, we decreased our falls a lot in acute medical. We find on our unit that side rails in the acutely confused or delerious can sometimes do more harm than good at the first sign that the patient is trying to climb out of bed, the mattress is placed on the floor. Certainly if a competent patient refused to have the rails up ( and full explanation should be given and permission asked before putting up the rails) you should comply with their wishes and document this. I think you would be more negligent in letting a narcotised patient fall than in putting side rails up, but i think you'll find this is a grey area in a lot of places. You should always document your use of side rails, and check regularly on the patient. However, we don't treat use of siderails in the same way that we treat use of other physical restraints eg shackles, because we don't obtain authorisation for use or document checks. You could consider siderails a form of restraint in that they fit the broad definition of limiting the freedom of the patient.
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