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Reading Lists:   Danger of Deaths Associated with Side Rail Use

Back to BQA Memo 99-053


Feinsod, Fred, Moore, M., Levenson, S., "Eliminating Full-length Bed Side Rails from Long-Term Care Facilities," Nursing Home Medicine, The Annals of Long-Term Care, 1997.

Miles, Steven and Irvine, Patrick, "Deaths Caused by Physical Restraints," The Gerontologist, Vol. 32, No. 6, 1992.

Miles, Steven, "Restraints and Sudden Death," Letter to the Editor, Journal of the American Geriatrics Society, 41 (9), 1993.

Miles, Steven, "A Case of Death by Physical Restraint: New Lessons from a Photograph," Journal of the American Geriatrics Society, 44: 291-292, 1996.

Miles, Steven and Parker, Kara, "Pictures of Fatal Bedrail Entrapment," Letters to the Editor, American Family Physician, Vol. 58, No. 8, November 15, 1998.

Parker, Kara and Miles, Steven, "Deaths Caused by Bedrails," Journal of the American Geriatrics Society, Vol. 45, No. 7, July 1997.


Capezuti, E., Evans, L., Staumpf, N., and Maislin, G., "Physical Restraint Use and Falls in Nursing Home Residents," Journal of the American Geriatrics Society, June, 1996.

Capezuti, E., Evans, L., Staumpf, N., Maislin, G., and Grisso, J., "Relationship Between Physical Restraint and Falls and Injuries Among Nursing Home Residents," Journal of Gerontology, Medical Sciences, 1998, Vol. 53A, No. 1, M47-M52

Daltroy, L., Phillips, C., Eaton, H., Larson, M., Partridge, A., Logigian, A., and Liang, M., "Objectively Measuring Physical Ability in Elderly Persons: The Physical Capacity Evaluation," American Journal of Public Health, April, 1995.

Lipsitz, Lewis, "An 85-Year Old Woman with a History of Falls, Clinical Crossroads," Journal of the American Medical Association, July 3, 1996.

Meddaugh, Dorothy, Friendenberg, D., Knisley, R., "Special Socks for Special People: Falls in Special Care Units," Geriatric Nursing, January/February 1996.

Morse, Janice M., Preventing Patient Falls (book) SAGE Publications, ISBN: 0-7619-0593-6.

Pasqua, Sandy, "Fall Programs That Work," Contemporary Long Term Care, April 1996.

Province, M., et. al., "The Effects of Exercise on Falls in Elderly Patients," Journal of the American Medical Association, May 3, 1995.

Ray, Wayne A., et. al., "A Randomized Trial of a Consultation Service to Reduce Falls in Nursing Homes," Journal of the American Medical Association, August 20, 1997.

Thapa, P., P. Gordon, R. Fought, W. Ray, "Psychotropic Drugs and Risk of Recurrent Falls in Ambulatory Nursing Home Residents," American Journal of Epidemiology, Vol. 142, No. 2, 1995.

Tideiksaar, Rhein, "Preventing Falls: How to Identify Risk Facts, Reduce Complications," Geriatrics, February, 1996.

Tinetti, Mary E., W. L. Liu, E. Claus, "Predictors and Prognosis of Inability to Get Up After Falls Among Elderly Persons," Journal of the American Medical Association, January 6, 1993.

Tinetti, Mary E., "Prevention of Falls and Fall Injuries in Elderly Persons: A Research Agenda," Preventative Medicine, 23, 756-762, 1994.

Tinetti, Mary E., S. Inouye, T. Gill, J. Doucette, "Shared Risk Factors for Falls, Incontinence, and Functional Dependence," Journal of the American Medical Association, May 3, 1995.


"Avoiding Physical Restraints. What All Nursing Home Residents and Families Need to Know," Pamphlet PSL-3113, Wisconsin Department of Health and Family Services, Division of Supportive Living, Bureau of Quality Assurance, May 1998.

Copies may be obtained by calling any regional office of the Bureau of Quality Assurance or by writing to:  Bureau of Quality Assurance, P.O. Box 2969, Madison, WI 53701-2969

"Avoiding Physical Restraint Use: New Standards in Care, A guide for residents, families and friends," booklet produced by the National Citizens Coalition for Nursing Home Reform (NCCNHR), copyright 1993.

Copies may be obtained by contacting them at:  National Citizens Coalition for Nursing Home Reform, 1224 16th Street N.W., Suite 202, Washington, D.C. 20036-2211, (202) 332-2275

"Avoiding Drugs Used as Chemical Restraints: New Standards in Care," a booklet addressing avoiding unnecessary drugs is available from the same organization, NCCNHR.

"A Family Guide to Restraint-Free Care," video for families from the video series, "Everyone Wins! Quality Care Without Restraints."

Available from:  The Independent Production Fund, 45 West 45th Street

New York, NY 10036, 1-800-727-2470

"Safety Without Restraints," illustrated booklet published by the Minnesota Department of Health. For additional copies, call (651) 215-8700 or visit their Website at: (exit DHFS)


Many resources geared toward physicians and nursing home staff are also helpful for hospital staff, especially regarding falls and restraint deaths from side rails. The articles listed below are of particular interest to hospital staff members.

"Strategies to Reduce Use of Restraints, Special Report - Restraint and Seclusion Standards," Joint Commission Perspectives, November-December 1997, pages 18-24.

Bryant, H. and Fernald, L., "Nursing Knowledge and Use of Restraint Alternatives: Acute and Chronic Care," Geriatric Nursing 18, 1997.

Clifford, Timothy, M.D., Medical Director, Maine Medicaid Program, "Why Are Hospitals Dangerous for Nursing Home Residents?," published in "Case Mix Update, A Newsletter of the Maine Case Mix Payment and Quality Assurance Project, May 1997.

Greenberg, R., "OBRA’s Challenge to Physical Therapy: Find Alternatives to Physical Restraints," PT Bulletin, April 26, 1996, p. 11.

Janelli, L.M., "Physical Restraint Use in Acute Care Settings," Journal of Nursing Care Quality. April 1195 9(3) p.86-92.

Mion, L. C., Minnick A. and Palmer, R., "Physical Restraint Use in the Hospital Setting: Unresolved Issues and Directions for Research," The Milbank Quarterly, 74 (3), 1996.

Robinson, B.E., "Death by Destruction of Will: Lest We Forget," Archives of Internal Medicine, Nov. 13, 1995.

Strumpf, Neville E., RN, FAAN, and Doris Schwartz, "Achieving Restraint-Free Care in Hospital Settings," Gerontological Nursing School of Nursing, University of Pennsylvania, published in "Untie the Elderly," Newsletter, December, 1997.

Winslow, Elizabeth H., RN, FAAN, Presbyterian Hospital, Dallas, Texas, "Do Restraints Really Protect Intubated Patients?," American Journal of Nursing, June, 1996.


Joint Commission on Accreditation of Healthcare Organizations (JCAHO)
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Oakbrook Terrace, IL 60181


Multiple resources listed here are appropriate for hospital and nursing home staff, as well as physicians. The sections on falls and side rails are also of particular interest to physicians and professional staff.

Castle, Nicholas, and Fogel, Barry, "Characteristics of Nursing Homes That Are Restraint Free," The Gerontologist, Vol. 38, No. 2, 1998.

Dunbar, Joan R., Neufeld, H. White and L. Libow, "Retrain, Don’t Restrain: The Educational Intervention of the National Nursing Home Restraint Removal Project," The Gerontologist, Vol. 36, No. 4, 1996.

Frengley, J.D. "The Use of Physical Restraints and the Absence of Kindness," Journal of the American Geriatrics Society, 44:1125-1127, 1996.

Frank, Christopher, Hodgetts, Geoffrey and Puxty, John, "Safety and Efficacy of Physical Restraints for the Elderly, Review of the Evidence," Canadian Family Physician, December, 1996.

Kapp, Marshall, "Nursing Home Restraints and Legal Liability," The Journal of Legal Medicine, 1992.

Morley, John E., "Update on Nursing Home Care," Annals of Long-Term Care, Vol. 7, No. 1, January 1999.

Schieb, David, Protas, Elizabeth, Hasson, Scott M., "Special Feature: Implications of Physical Restraint and Restraint Reduction of Older Persons," Topics in Geriatric Rehabilitation, December, 1996.


Cohen, Camille, R. Neufeld, J. Dunbar, L. Pflug, B. Breuer, "Old Problems, Different Approach: Alternatives to Physical Restraints," Journal of Gerontological Nursing, February, 1996.

Colorado Foundation for Medical Care, "Assessment and Alternatives Help Guide, Restraint Reduction, Falls, Behavior Problems, Wandering," Phone #303-695-3300, Ext. 3005.

Dunbar, Joan, et. al., "Taking Charge, The Role of Nursing Administrators in Removing Restraints," Journal of Nursing Administration, Vol. 27, No. 3, March 1997.

Ejay, F. K., Rose, M. S. and Jones, J. A., "Changes in Attitudes Toward Restraints Among Nursing Home Staff and Residents’ Families Following Restraint Reduction," The Journal of Applied Gerontology 15 (4), 1996.

Evans, Lois and Strumpf, Neville, "Myths About Elder Restraint," IMAGE: Journal of Nursing Scholarship, Vol. 22, No. 2, 1990.

Fleming, Kevin, "Changing Physician Behavior," Topics in Geriatric Medicine and Medical Direction, Vol. 13, Issue 4, December, 1998.

McHutchion, E., and Morse, J., "Releasing Restraints, A Nursing Dilemma," Journal of Gerontological Nursing, Vol. 15, No. 2, 1989.

Neufeld, R. R. and Dunbar, J. M., "Restraint Reduction: Where Are We Now?," Nursing Home Economics 4 (3), 1997.

Newbern, Virginia and Lindsey, Ina, "Attitudes of Wives Toward Having Their Elderly Husbands Restrained," Geriatric Nursing, Vol. 15, No. 3, May/June 1994.

Rader, Joanne, "A Comprehensive Staff Approach to Problem Wandering," The Gerontologist, Vol. 27, No. 6, 1987.

Rader, Joanne, J. Doan and Sr. M. Schwab, "How to Decrease Wandering, a Form of Agenda Behavior," Geriatric Nursing, July/August, 1985.

Strumpf, Neville and Evans, Lois, "The Ethical Problems of Prolonged Physical Restraint," Journal of Gerontological Nursing, Vol. 17, No. 2, 1991.

Werner, P., Koroknay, Braun and Cohen-Mansfield, "Individualized Care Alternatives Used in the Process of Removing Physical Restraints in the Nursing Home," Journal of the American Geriatrics Society, 42 (3), 1994.