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

To purchase or authenticate to the full-text of this article, please visit this link: http://dx.doi.org/10.1111/j.1532-5415.2007.01082.x Byline: Elizabeth Capezuti (*), Laura M. Wagner ([dagger]), Barbara L. Brush ([double dagger]), Marie Boltz (*), Susan Renz (s.), Karen A. Talerico ([parallel]) Keywords: treatment implementation; side rail; advanced practice nurse; nursing homes; physical restraint Abstract: 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 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. Author Affiliation: (*)John A. Hartford Foundation Institute for Geriatric Nursing, New York University College of Nursing, New York, New York ([dagger])Kunin-Lunenfeld Applied Research Unit at Baycrest, Toronto, Ontario, Canada ([double dagger])University of Michigan School of Nursing, Ann Arbor, Michigan (s.)RS Connection, Inc., West Chester, Pennsylvania ([parallel])Amann Talerico Consulting, Portland, Oregon Article note: 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