Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2016 Jan 26:352:h6781.
doi: 10.1136/bmj.h6781.

6-PACK programme to decrease fall injuries in acute hospitals: cluster randomised controlled trial

Anna L Barker  1 , Renata T Morello  2 , Rory Wolfe  2 , Caroline A Brand  2 , Terry P Haines  3 , Keith D Hill  4 , Sandra G Brauer  5 , Mari Botti  6 , Robert G Cumming  7 , Patricia M Livingston  6 , Catherine Sherrington  8 , Silva Zavarsek  9 , Richard I Lindley  8 , Jeannette Kamar  10
Affiliations
Randomized Controlled Trial

6-PACK programme to decrease fall injuries in acute hospitals: cluster randomised controlled trial

Anna L Barker et al. BMJ. .

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.

PubMed Disclaimer

Conflict of interest statement

Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: no support from any organisation for the submitted work other than that detailed above; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.

Figures

None
Fig 1 Flow of wards and patients through trial. *Three ward pairs ceased observation at 11 months owing to ward closures
None
Fig 2 Rate of use of 6-PACK programme components (fall risk tool and six interventions—that is, maximum uptake of 7 per occupied bed day) by month and group
None
Fig 3 Use of 6-PACK programme components during randomised controlled trial period by group
None
Fig 4 Fall outcomes by month and group
None
Fig 5 Use of 6-PACK programme components with 100% adherence target and falls by day of ward admission for intervention ward patients
See this image and copyright information in PMC

Comment in

References

    1. Royal College of Physicians. Report of the 2011 inpatient falls pilot audit.RCP, 2012.
    1. Jørgensen TS, Hansen AH, Sahlberg M et al. Nationwide time trends and risk factors for in-hospital falls-related major injuries. Int J Clin Pract 2015;69: 703-9. 10.1111/ijcp.12624 25707918 - DOI - PubMed
    1. Wong CA, Recktenwald AJ, Jones ML, Waterman BM, Bollini ML, Dunagan WC.. The cost of serious fall-related injuries at three Midwestern hospitals. Jt Comm J Qual Patient Saf 2011;37: 81-7. 21939135 - PubMed
    1. Morello RT, Barker AL, Watts JJ et al. The extra resource burden of in-hospital falls: a cost of falls study. Med J Aust 2015;203: 367-76. 10.5694/mja15.00296 26510807 - DOI - PubMed
    1. National Institute for Health and Care Excellence. Falls: assessment and prevention of falls in older people.NICE, 2013. - PubMed

Publication types