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

(See editorial comments by Drs. Magaziner, Miller, and Resnick on pp 464–466)

  1. Elizabeth Capezuti PhD, RN,
  2. Laura M. Wagner PhD, RN,
  3. Barbara L. Brush PhD, RN,
  4. Marie Boltz MSN, RN,
  5. Susan Renz MSN, RN,
  6. Karen A. Talerico PhD, RN

Article first published online: 21 FEB 2007

DOI: 10.1111/j.1532-5415.2007.01082.x

Issue

Journal of the American Geriatrics Society

Journal of the American Geriatrics Society

Volume 55, Issue 3, pages 334–341, March 2007

Additional Information

How to Cite

Capezuti, E., Wagner, L. M., Brush, B. L., Boltz, M., Renz, S. and Talerico, K. A. (2007), Consequences of an Intervention to Reduce Restrictive Side Rail Use in Nursing Homes. Journal of the American Geriatrics Society, 55: 334–341. doi: 10.1111/j.1532-5415.2007.01082.x

Author Information

  1. From the *John A. Hartford Foundation Institute for Geriatric Nursing, New York University College of Nursing, New York, New York†Kunin-Lunenfeld Applied Research Unit at Baycrest, Toronto, Ontario, Canada‡University of Michigan School of Nursing, Ann Arbor, Michigan§RS Connection, Inc., West Chester, Pennsylvania∥Amann Talerico Consulting, Portland, Oregon.

*Address correspondence to Elizabeth Capezuti, PhD, RN, FAAN, Associate Professor, Co-Director, John A. Hartford Foundation Institute for Geriatric Nursing, New York University College of Nursing, 246 Greene Street, 6th Floor, New York, NY 10003. E-mail: ec65@nyu.edu

Publication History

  1. Issue published online: 2 MAR 2007
  2. Article first published online: 21 FEB 2007

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Keywords:

  • treatment implementation;
  • side rail;
  • advanced practice nurse;
  • nursing homes;
  • physical restraint

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.

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