Danger of Deaths Associated with Side Rail Use
Back to BQA Memo 99-053
RISKS & DANGERS OF SIDE RAILS
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,
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.
INFORMATION ON PREVENTING FALLS
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,
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:
Pasqua, Sandy, "Fall Programs That Work," Contemporary Long Term Care, April
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,
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.
INFORMATION FOR FAMILIES
"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,
"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
INFORMATION FOR HOSPITAL STAFF
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., "OBRAs 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,
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,
Joint Commission on Accreditation of Healthcare Organizations (JCAHO)
One Renaissance Boulevard
Oakbrook Terrace, IL 60181
INFORMATION FOR PHYSICIANS
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, Dont 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.
INFORMATION FOR NURSING HOME STAFF
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.
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.