6-PACK programme to decrease fall injuries in acute hospitals

Cluster randomised controlled trial

Anna L. Barker, Renata T. Morello, Rory Wolfe, Caroline A. Brand, Terry P. Haines, Keith D. Hill, Sandra G. Brauer, Mari Botti, Robert G. Cumming, Patricia M. Livingston, Catherine Sherrington, Silva Zavarsek, Richard I. Lindley, Jeannette Kamar

Research output: Contribution to journalArticleResearchpeer-review

39 Citations (Scopus)

Abstract

OBJECTIVE: To evaluate the effect of the 6-PACK programme on falls and fall injuries in acute wards. DESIGN: Cluster randomised controlled trial. SETTING: Six Australian hospitals. PARTICIPANTS: All patients admitted to 24 acute wards during the trial period. INTERVENTIONS: Participating wards were randomly assigned to receive either the nurse led 6-PACK programme or usual care over 12 months. The 6-PACK programme included a fall risk tool and individualised use of one or more of six interventions: "falls alert" sign, supervision of patients in the bathroom, ensuring patients' walking aids are within reach, a toileting regimen, use of a low-low bed, and use of a bed/chair alarm. MAIN OUTCOME MEASURES: The co-primary outcomes were falls and fall injuries per 1000 occupied bed days. RESULTS: During the trial, 46 245 admissions to 16 medical and eight surgical wards occurred. As many people were admitted more than once, this represented 31 411 individual patients. Patients' characteristics and length of stay were similar for intervention and control wards. Use of 6-PACK programme components was higher on intervention wards than on control wards (incidence rate ratio 3.05, 95% confidence interval 2.14 to 4.34; P<0.001). In all, 1831 falls and 613 fall injuries occurred, and the rates of falls (incidence rate ratio 1.04, 0.78 to 1.37; P=0.796) and fall injuries (0.96, 0.72 to 1.27; P=0.766) were similar in intervention and control wards. CONCLUSIONS: Positive changes in falls prevention practice occurred following the introduction of the 6-PACK programme. However, no difference was seen in falls or fall injuries between groups. High quality evidence showing the effectiveness of falls prevention interventions in acute wards remains absent. Novel solutions to the problem of in-hospital falls are urgently needed. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12611000332921.

Original languageEnglish
Article numberh6781
JournalBMJ: British Medical Journal
Volume352
DOIs
Publication statusPublished - 26 Jan 2016

Cite this

Barker, Anna L. ; Morello, Renata T. ; Wolfe, Rory ; Brand, Caroline A. ; Haines, Terry P. ; Hill, Keith D. ; Brauer, Sandra G. ; Botti, Mari ; Cumming, Robert G. ; Livingston, Patricia M. ; Sherrington, Catherine ; Zavarsek, Silva ; Lindley, Richard I. ; Kamar, Jeannette. / 6-PACK programme to decrease fall injuries in acute hospitals : Cluster randomised controlled trial. In: BMJ: British Medical Journal. 2016 ; Vol. 352.
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abstract = "OBJECTIVE: To evaluate the effect of the 6-PACK programme on falls and fall injuries in acute wards. DESIGN: Cluster randomised controlled trial. SETTING: Six Australian hospitals. PARTICIPANTS: All patients admitted to 24 acute wards during the trial period. INTERVENTIONS: Participating wards were randomly assigned to receive either the nurse led 6-PACK programme or usual care over 12 months. The 6-PACK programme included a fall risk tool and individualised use of one or more of six interventions: {"}falls alert{"} sign, supervision of patients in the bathroom, ensuring patients' walking aids are within reach, a toileting regimen, use of a low-low bed, and use of a bed/chair alarm. MAIN OUTCOME MEASURES: The co-primary outcomes were falls and fall injuries per 1000 occupied bed days. RESULTS: During the trial, 46 245 admissions to 16 medical and eight surgical wards occurred. As many people were admitted more than once, this represented 31 411 individual patients. Patients' characteristics and length of stay were similar for intervention and control wards. Use of 6-PACK programme components was higher on intervention wards than on control wards (incidence rate ratio 3.05, 95{\%} confidence interval 2.14 to 4.34; P<0.001). In all, 1831 falls and 613 fall injuries occurred, and the rates of falls (incidence rate ratio 1.04, 0.78 to 1.37; P=0.796) and fall injuries (0.96, 0.72 to 1.27; P=0.766) were similar in intervention and control wards. CONCLUSIONS: Positive changes in falls prevention practice occurred following the introduction of the 6-PACK programme. However, no difference was seen in falls or fall injuries between groups. High quality evidence showing the effectiveness of falls prevention interventions in acute wards remains absent. Novel solutions to the problem of in-hospital falls are urgently needed. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12611000332921.",
author = "Barker, {Anna L.} and Morello, {Renata T.} and Rory Wolfe and Brand, {Caroline A.} and Haines, {Terry P.} and Hill, {Keith D.} and Brauer, {Sandra G.} and Mari Botti and Cumming, {Robert G.} and Livingston, {Patricia M.} and Catherine Sherrington and Silva Zavarsek and Lindley, {Richard I.} and Jeannette Kamar",
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6-PACK programme to decrease fall injuries in acute hospitals : Cluster randomised controlled trial. / Barker, Anna L.; Morello, Renata T.; Wolfe, Rory; Brand, Caroline A.; Haines, Terry P.; Hill, Keith D.; Brauer, Sandra G.; Botti, Mari; Cumming, Robert G.; Livingston, Patricia M.; Sherrington, Catherine; Zavarsek, Silva; Lindley, Richard I.; Kamar, Jeannette.

In: BMJ: British Medical Journal, Vol. 352, h6781, 26.01.2016.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - 6-PACK programme to decrease fall injuries in acute hospitals

T2 - Cluster randomised controlled trial

AU - Barker, Anna L.

AU - Morello, Renata T.

AU - Wolfe, Rory

AU - Brand, Caroline A.

AU - Haines, Terry P.

AU - Hill, Keith D.

AU - Brauer, Sandra G.

AU - Botti, Mari

AU - Cumming, Robert G.

AU - Livingston, Patricia M.

AU - Sherrington, Catherine

AU - Zavarsek, Silva

AU - Lindley, Richard I.

AU - Kamar, Jeannette

PY - 2016/1/26

Y1 - 2016/1/26

N2 - OBJECTIVE: To evaluate the effect of the 6-PACK programme on falls and fall injuries in acute wards. DESIGN: Cluster randomised controlled trial. SETTING: Six Australian hospitals. PARTICIPANTS: All patients admitted to 24 acute wards during the trial period. INTERVENTIONS: Participating wards were randomly assigned to receive either the nurse led 6-PACK programme or usual care over 12 months. The 6-PACK programme included a fall risk tool and individualised use of one or more of six interventions: "falls alert" sign, supervision of patients in the bathroom, ensuring patients' walking aids are within reach, a toileting regimen, use of a low-low bed, and use of a bed/chair alarm. MAIN OUTCOME MEASURES: The co-primary outcomes were falls and fall injuries per 1000 occupied bed days. RESULTS: During the trial, 46 245 admissions to 16 medical and eight surgical wards occurred. As many people were admitted more than once, this represented 31 411 individual patients. Patients' characteristics and length of stay were similar for intervention and control wards. Use of 6-PACK programme components was higher on intervention wards than on control wards (incidence rate ratio 3.05, 95% confidence interval 2.14 to 4.34; P<0.001). In all, 1831 falls and 613 fall injuries occurred, and the rates of falls (incidence rate ratio 1.04, 0.78 to 1.37; P=0.796) and fall injuries (0.96, 0.72 to 1.27; P=0.766) were similar in intervention and control wards. CONCLUSIONS: Positive changes in falls prevention practice occurred following the introduction of the 6-PACK programme. However, no difference was seen in falls or fall injuries between groups. High quality evidence showing the effectiveness of falls prevention interventions in acute wards remains absent. Novel solutions to the problem of in-hospital falls are urgently needed. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12611000332921.

AB - OBJECTIVE: To evaluate the effect of the 6-PACK programme on falls and fall injuries in acute wards. DESIGN: Cluster randomised controlled trial. SETTING: Six Australian hospitals. PARTICIPANTS: All patients admitted to 24 acute wards during the trial period. INTERVENTIONS: Participating wards were randomly assigned to receive either the nurse led 6-PACK programme or usual care over 12 months. The 6-PACK programme included a fall risk tool and individualised use of one or more of six interventions: "falls alert" sign, supervision of patients in the bathroom, ensuring patients' walking aids are within reach, a toileting regimen, use of a low-low bed, and use of a bed/chair alarm. MAIN OUTCOME MEASURES: The co-primary outcomes were falls and fall injuries per 1000 occupied bed days. RESULTS: During the trial, 46 245 admissions to 16 medical and eight surgical wards occurred. As many people were admitted more than once, this represented 31 411 individual patients. Patients' characteristics and length of stay were similar for intervention and control wards. Use of 6-PACK programme components was higher on intervention wards than on control wards (incidence rate ratio 3.05, 95% confidence interval 2.14 to 4.34; P<0.001). In all, 1831 falls and 613 fall injuries occurred, and the rates of falls (incidence rate ratio 1.04, 0.78 to 1.37; P=0.796) and fall injuries (0.96, 0.72 to 1.27; P=0.766) were similar in intervention and control wards. CONCLUSIONS: Positive changes in falls prevention practice occurred following the introduction of the 6-PACK programme. However, no difference was seen in falls or fall injuries between groups. High quality evidence showing the effectiveness of falls prevention interventions in acute wards remains absent. Novel solutions to the problem of in-hospital falls are urgently needed. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12611000332921.

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U2 - 10.1136/bmj.h6781

DO - 10.1136/bmj.h6781

M3 - Article

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JO - BMJ: British Medical Journal

JF - BMJ: British Medical Journal

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