Consequences of an Intervention to Reduce Restrictive Side Rail Use in Nursing Homes

• Published in: Journal of the American Geriatrics Society (JAGS) Vol. 55; no. 3; pp. 334 - 341
• Main Authors: Capezuti, Elizabeth, Wagner, Laura M., Brush, Barbara L., Boltz, Marie, Renz, Susan, Talerico, Karen A.
• Format: Journal Article
• Language: English
• Published: Malden, USA Blackwell Publishing Inc 01.03.2007; Blackwell; Wiley Subscription Services, Inc
• Subjects: Accident prevention; Accidental Falls - prevention & control; Accidental Falls - statistics & numerical data; advanced practice nurse; Aged; Aged, 80 and over; Beds; Beds - adverse effects; Beds - standards; Biological and medical sciences; Cross-Sectional Studies; Falls; Female; General aspects; Health participants; Homes for the Aged - statistics & numerical data; Humans; Male; Medical sciences; Nurse Practitioners; Nursing homes; Nursing Homes - statistics & numerical data; Older people; physical restraint; Prevention and actions; Program Evaluation; Public health. Hygiene; Public health. Hygiene-occupational medicine; Referral and Consultation; Restraint, Physical - adverse effects; Restraint, Physical - instrumentation; Restraint, Physical - utilization; Safety Management - organization & administration; Safety Management - utilization; side rail; treatment implementation; United States; United States; Human; Long stay; side rail; Nursing home for the aged; Health staff; Use; Care; Prevention; treatment implementation; Gerontology; Treatment; physical restraint; Professional practice; Restraint; Advanced stage; advanced practice nurse; Homes for the aged; Nursing home; Elderly; nursing homes; Geriatrics; Nurse
• ISSN: 0002-8614; 1532-5415
• DOI: 10.1111/j.1532-5415.2007.01082.x

OBJECTIVES: To examine the effect of an advanced practice nurse (APN) intervention on restrictive side rail usage in four nursing homes and with a sample of 251 residents. A secondary question explored the association between restrictive side rail reduction and bed‐related falls. DESIGN: Pre‐ and posttest design. SETTING: Four urban nursing homes. PARTICIPANTS: All nursing home residents present in the nursing home at three time points (n=710, 719, and 707) and a subset of residents (n=251) with restrictive side rail use at baseline. INTERVENTION: APN consultation with individual residents and facility‐wide education and consultation. MEASUREMENTS: Direct observation of side rail status, resident and nurse interview for functional status, mobility, cognition, behavioral symptoms, medical record review for demographics and treatment information, and incident reports for fall data. RESULTS: At the institutional level, one of the four nursing homes significantly reduced restrictive side rail use (P=.01). At the individual participant level, 51.4% (n=130) reduced restrictive side rail use. For the group that reduced restrictive side rails, there was a significantly (P<.001) reduced fall rate (−0.053; 95% confidence interval (CI)=−0.083 to −0.024), whereas the group that continued restrictive side rail did not demonstrate a significantly (P=.17) reduced fall rate (−0.013; 95% CI=−0.056–0.030). CONCLUSION: An APN consultation model can safely reduce side rail use. Restrictive side rail reduction does not lead to an increase in bed‐related falls. Although side rails serve many purposes, routine use of these devices to restrict voluntary movement and prevent falls is not supported.