Are Side Rails a Help or a Hindrance?

For many years, it was assumed that side rails were a deterrent to patient falls. Intuitively, this makes sense. However, recent research and evidence-based practice indicate that the use of side rails can actually increase the risk of falls. They also increase the risk of injury, either from entrapment in the rail, or from falling over the siderail, which is higher than the bed itself.

So what is the evidence? In a study published in 2002 (Capezuti, et.al.) it was noted that the use of siderails did not decrease the number of falls.  Since entrapment within the siderails is a noted problem, and since siderails are considered a restraint in long term care, the use of siderails as a fall prevention strategy is strongly discouraged.

But if siderails don’t prevent falls, what alternatives do nurses have in order to prevent  patients from falling and the possible injuries that might occur? Nurses and organizations across the country are struggling with this issue.

A valid and reliable fall assessment tool assists the healthcare provider in identifying which patients may be at risk. Once the risk is identified, both standard and individualized interventions are put into place to reduce the external risk factors and to communicate with the staff about the patients’ internal risk factors. This might include using a particular bracelet color, socks or slippers with tread on them, a color code on the door, moving the patient closer to the nurses’ stations, and communicating with patients, family and staff that a particular patient is at risk for falling.

So, rather than turning to side rails to help prevent falls, assess your patients thoroughly, communicate your assessment to other staff, and implement interventions to decrease the risk of falling.

Capezuti E et al. Side rail use and bed-related fall outcomes among nursing home residents. Journal of the American Geriatrics Society 2002;50(1):90-96.