Bed rails: a barrier to independence?

Minimizing the use of restrictive devices in dementia patients at risk for falling

The accumulating empirical evidence demonstrates that restrictive devices can be removed without negative consequences. Most importantly, use of nonrestrictive measures has been correlated with positive patient outcomes and represents care that is dignified and safe for confused elders. Most of these nonrestrictive approaches promote mobility and functional recovery; however, testing of individual interventions is needed to further the science. As the research regarding restrictive devices has been translated into professional guidelines and regulatory standards, the prevalence of usage has declined dramatically. New institutional models of care discouraging routine use of restrictive devices also will foster innovative solutions to clinical problems associated with dementia.

An analysis of falls in the hospital: can we do without bedrails?

OBJECTIVES

To determine the effects of introduction of a bedrail policy, and an educational program, on patient falls and fall-related injuries.

DESIGN

A prospective "Before and After" design.

PARTICIPANTS AND SETTING

All patients admitted during 1 calendar year in an assessment, treatment, and rehabilitation unit for older people.

INTERVENTION

A policy change for the use of bedrails (restricting their use) and an educational program about their effects.

MEASUREMENTS

Patient fall rates -- all falls and around the bed falls -- and patient and staff injuries.

RESULTS

There was a significant reduction in the number of beds with bedrails attached after the policy introduction (mean of 40/135 vs 18.5/135, respectively, P = .02), but the fall rate (either total or around the bed) did not change significantly. Serious injuries were significantly less common after the bedrail policy was introduced (P = .008), with fewer head injuries.

CONCLUSIONS

Reducing the use of bedrails did not alter patient fall rates significantly, but it was associated with a reduction in serious injuries. Unless it can be shown that bedrails are beneficial, their continued use in older patients must be seriously questioned.