Side Rail Use and Bed‐Related Fall Outcomes Among Nursing Home Residents

Capezuti, Elizabeth; Maislin, Greg; Strumpf, Neville E.; Evans, Lois K.

doi:10.1046/j.1532-5415.2002.50013.x

Cited by 105 publications

(84 citation statements)

References 50 publications

(104 reference statements)

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“…Our findings are contrary to a nursing home study that found that bilateral side rail use did not decrease the risk of falls. 34 However, their comparison group was having no or 1 side rail raised, while ours was having no rails raised. It is also interesting to note that our study showed that having 1 to 2 bed rails raised is just as effective in reducing the risk of falling as having 3 to 4 rails raised.…”

Section: Discussionmentioning

confidence: 99%

A case-control study of patient, medication, and care-related risk factors for inpatient falls

et al. 2005

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OBJECTIVE: To comprehensively analyze potential risk factors for falling in the hospital and describe the circumstances surrounding falls.DESIGN: Case-control study. Data on potential risk factors and circumstances of the falls were collected via interviews with patients and/ or nurses and review of adverse event reports, medical records, and nurse staffing records.SETTING: Large urban academic hospital.PATIENTS: Ninety-eight inpatients who fell and 318 controls matched on approximate length of stay until the index fall. MEASUREMENTS AND MAIN RESULTS:In a multivariate model of patient-related, medication, and care-related variables, factors that were significantly associated with an increased risk of falling included: gait/balance deficit or lower extremity problem (adjusted odds ratio [aOR], 9.0; 95% confidence interval [CI], 2.0 to 41.0), confusion (aOR, 3.6; 95% CI, 1.6 to 8.4), use of sedatives/hypnotics (aOR, 4.3; 95% CI, 1.6 to 11.5), use of diabetes medications (aOR, 3.2; 95% CI, 1.3 to 7.9), increasing patient-to-nurse ratio (aOR, 1.6; 95% CI, 1.2 to 2.0), and activity level of ''up with assistance'' compared with ''bathroom privileges'' (aOR, 8.7; 95% CI, 2.3 to 32.7). Urinary or stool frequency or incontinence was of borderline significance (aOR, 2.3; 95% CI, 0.99 to 5.6). Having one or more side rails raised was associated with a decreased risk of falling (aOR, 0.006; 95% CI, 0.001 to 0.024).CONCLUSIONS: Patient health status, especially abnormal gait or lower extremity problems, medications, as well as care-related factors, increase the risk of falling. Fall prevention programs should target patients with these risk factors and consider using frequently scheduled mobilization and toileting, and minimizing use of medications related to falling. Due to the risk of significant injury and the increased cost, reduction of falls in hospitals is a major priority for hospital quality and patient safety. While falls have been relatively well studied in community and nursing home settings, less is known about the prevention of hospital falls. Previous research has identified risk factors for falling in the hospital, including impaired balance or gait, history of falling, increasing age, impaired cognition, depression, dizziness or vertigo, orthostatic hypotension, visual impairment, urinary frequency, nocturia, incontinence, specific diagnoses, and use of certain medications, such as benzodiazepines, antipsychotics, and sedatives. 10,[12][13][14][15][16][17][18] Yet comparative studies on hospital falls have been limited in several ways, including variations in study design, setting, patient population, and definitions of risk factors. Some studies have continued to focus solely on the elderly or relied only on data included in hospital incident reports or chart review. Furthermore, environmental and care-related factors, including patient-to-nurse ratio, are often overlooked as potential risk factors for falling in these studies. Because fall prevention programs should be linked to the etiologic factors of fa...

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Section: Discussionmentioning

confidence: 99%

A case-control study of patient, medication, and care-related risk factors for inpatient falls

et al. 2005

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“…Most disturbing was our finding of 15 incidents, representing 7 participants, who were observed with their arms or legs within the side rails. Considering the lack of evidence supporting the use of side rails (Capezuti et al, 2002(Capezuti et al, , 2007Oliver, 2002) in bed-related fall prevention and their potential fatal consequences (JCAHO, 2002), use of these devices should be limited to in-bed and transfer enablers but may require modification to reduce entrapment risk (Powell-Cope et al, 2005). …”

Section: Discussionmentioning

confidence: 99%

“…Most falls in nursing homes occur in the resident's room, especially during attempts to get in or out of bed (Agostini et al, 2001;Capezuti et al, 2002). Bed-exit alarms, designed to detect patient's movement out of bed, increase staff surveillance of cognitively and/or physically impaired residents at risk for bed-related falls.…”

Section: Introductionmentioning

confidence: 99%

Bed-exit alarm effectiveness

Capezuti

Brush

Lane

et al. 2009

Archives of Gerontology and Geriatrics

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This study describes the accuracy of two types of bed-exit alarms to detect bed-exiting body movements: pressure-sensitive and a pressure sensitive combined with infrared beam detectors (dual sensor system). We also evaluated the occurrence of nuisance alarms, or alarms that are activated when a participant does not attempt to get out of bed. Fourteen nursing home residents were directly observed for a total of 256 nights or 1,636.5 hours; an average of 18.3 ± 22.3 (± S.D.) nights/ participant for an average of 6.4 ± 1.2 hours/night. After adjusting for body movements via repeated measures, Poisson regression modeling, the least squares adjusted means show a marginally significant difference between the type of alarm groups on the number of true positives (mean/S.E.M. = 0.086/1.617) for pressure-sensitive vs. dual sensor alarm (0.593/1.238; p = 0.0599) indicating that the dual sensor alarm may have a higher number of true positives. While the dual sensor bed-exit alarm was more accurate than the pressure sensitive alarm in identifying bed-exiting body movements and reducing the incidence of false alarms, false alarms were not eliminated altogether. Alarms are not a substitute for staff; adequate staff availability is still necessary when residents need or wish to exit bed.

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“…In the subsequent secondary analysis of 319 nursing home residents with consistent bilateral bed rail use during the nighttime, those with dementia and behavioral symptoms were more likely to be restrained despite the finding that the bed rails did not significantly reduce the likelihood of falls, recurrent falls or serious injuries. 15 A gerontologic CNS intervention coupled with staff education was successful in reducing restraint use in hospitalized nursing home patients. 16 This randomized controlled trial engaged the gerontologic CNS in an admission assessment to assess fall risk within 12 to 36 hours, develop an individualized care plan to meet the patient's needs (especially to prevent restraint use), and to reassess and monitor high risk patients regularly.…”

Section: Research Findingsmentioning

confidence: 99%

Restraint free care in older adults with dementia

Cotter

2005

Keio J. Med.

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Abstract. During the past two decades, significant research and several government and health care quality groups have advised against the use of physical restraints in hospitals and nursing homes, yet older adults are continuing to die, become injured or experience the iatrogenic complications associated with this practice. Deaths are usually caused by asphyxiation, but also occur from strangulation, or cardiac arrest. Older adults with dementia are at high risk for restraint use because of impaired memory, language, judgment and visual perception. In moderate to severe dementia, the risk of falls is greater because of gait apraxia and unsteadiness. Agitation, disorientation, and pacing behaviors from delirium or dementia can precipitate staff to use restraints to prevent harm to the older adult or to others. Physical restraints should be eliminated as an intervention in older adults with dementia because they are also very likely to cause acute functional decline, incontinence, pressure ulcers and regressive behaviors in a short period of time. The purpose of this paper is to disseminate the dangers of this clinical practice and to summarize the latest research in restraint free care and restraint alternatives in the United States.

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Side Rail Use and Bed‐Related Fall Outcomes Among Nursing Home Residents

Cited by 105 publications

References 50 publications

A case-control study of patient, medication, and care-related risk factors for inpatient falls

A case-control study of patient, medication, and care-related risk factors for inpatient falls

Bed-exit alarm effectiveness

Restraint free care in older adults with dementia

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