Bed rail removal doesn't increase falls in elderly
Last Updated: 2007-04-18 14:43:56 -0400 (Reuters Health)
By Anne Harding
NEW YORK (Reuters Health) - Reducing the use of restrictive side rails on the beds of nursing home residents does not increase the likelihood of falling, and may actually help prevent falls, a new study demonstrates.
Deaths and injuries have been linked to the use of full-length side rails, generally when patients try to climb over them and fall or become trapped against them, Dr. Elizabeth Capezuti of New York University College of Nursing in New York City and colleagues note.
While government regulators and professional groups now discourage the routine use of restrictive side rails, they add, "many nursing homes continue to use these devices inappropriately."
Capezuti and her team investigated whether having an advanced practice nurse work with four nursing homes to find alternatives to restrictive side rail use could reduce the use of the side rails and the risk of falling among the residents.
The subjects included more the 700 patients in an intervention group and 251 comparison subjects for whom no changes were made. The researchers evaluated the residents one month and one year after the advanced practice nurse completed the intervention.
Other alternatives to full-length side bars included installing shorter side rails that could be used as hand-holds; lowering the beds; providing physical therapy and rehabilitation to improve strength and balance; and providing bedside commodes and easy-to-use light switches.
In an interview with Reuters Health, Capezuti noted that confused or demented nursing home residents are most likely to suffer injury from the rails. Rather than seeing them as a signal that they should stay in bed and call for help in getting out, Capezuti explained, they may instead see the rails as obstacles to climb over or around. "Those are exactly the same people who are the ones who are the most likely to get themselves entangled and hurt."
One of the four nursing homes in the study reduced the use of restrictive side rails after the nursing intervention, after which the rate of falls among residents was significantly reduced. However, the rate of falls among residents of the three other nursing homes didn't change.
The researchers note that the nursing home that restricted side rail use had a religious affiliation and "a highly committed administrative staff," which likely helped make the nursing intervention more effective. In general, they add, nursing homes may not change their practices regarding side rails unless federal regulations regarding them are actually enforced.
Family members of nursing home residents should question staff about any use of restrictive side rails, Capezuti added. They should ask if the side rails conform with FDA guidelines or if something less restrictive can be used. "I think they should question just the routine usage of these devices," she added.
SOURCE: Journal of the American Geriatrics Society, March 2007.
