Side rail use and bed-related fall outcomes among nursing home residents.
OBJECTIVE
To analyze the effect of physical restraint reduction on nighttime side rail use and to examine the relationship between bilateral side rail use and bed-related falls/injuries among nursing home residents.


METHODS
Secondary analysis of data collected in a longitudinal, prospective clinical trial designed to reduce restraint use.


METHODS
Three nonprofit nursing homes.


METHODS
To examine the first question regarding the effect of physical restraint reduction on side rail usage, we included all nursing home residents who survived a 1-year data collection period (n = 463). To answer the second research question concerning the relationship between side rail status and bed-related falls, subjects' side rail status for each of the four data collection periods was compared. The sample for this analysis includes only those with consistent side rail status (n = 319) for the four observations periods: either 0/1 side rail (n = 188) or 2 (bilateral) side rails (n = 131).


METHODS
Side rail and restraint status was directly observed by two research assistants, twice each night shift (10 p.m.-6 a.m.) for three nights at each of four data collection points. Nighttime fall-related outcome data were obtained from a review of nursing home incident reports during the entire 1-year data collection period (T1 through T4). Cognitive status was measured using the Folstein Mini-Mental State Examination. Functional and behavioral status was obtained using subscales of the Psychogeriatric Dependency Rating Scale.


RESULTS
Over a 1-year period, there was an increase in the proportion of bilateral side rail use for all three nursing homes. Based on the multiple logistic regression analysis, there was no indication of a decreased risk of falls or recurrent falls with bilateral side rail use, controlling for cognition and functional and behavioral status (adjusted odds ratio (AOR) = 1.13, 95% confidence interval (CI) = 0.45,2.03). Similarly, bilateral side rail use did not reduce the risk of recurrent falls, controlling for cognition and functional status (AOR = 1.25, 95% CI = 0.33,4.67).


CONCLUSIONS
Despite high usage of bilateral side rails, they do not appear to significantly reduce the likelihood of falls, recurrent falls, or serious injuries. Bed-related falls remain clinically challenging. The data from this study, coupled with increasing reports of side rail-related injuries and deaths, compel us to seek and empirically test alternative interventions to prevent bed-related falls.
Capezuti
Elizabeth
E
School of Nursing and the Emory Center for Health in Aging, Emory University, Atlanta, GA 30329, USA.
Maislin
Greg
G
Strumpf
Neville
N
Evans
Lois K
LK
D000058:Accidental Falls / Q000517:prevention & control / Q000706:statistics & numerical data*; D000368:Aged; D000369:Aged, 80 and over; D001513:Beds; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D009735:Nursing Homes / Q000706:statistics & numerical data*; D012149:Restraint, Physical / Q000706:statistics & numerical data; D014481:United States