Educating nursing home staff on fracture prevention: a cluster randomised trial.
OBJECTIVE
to assess whether specialist osteoporosis nurses delivering training to care home staff can reduce fractures and improve the prescription of treatments to reduce fractures versus usual care.


METHODS
pragmatic cluster randomised controlled trial (RCT) with randomisation at the Primary Care Organisation (PCO) level.


METHODS
care homes (residential, nursing and EMI) across England and Wales within PCOs.


METHODS
all 300 PCOs in England and Wales were invited to take part. Of these, 58 agreed to participate and gained ethical approval in time to start the study: 29 clusters were randomised to the intervention group and 29 to the control.


METHODS
specialist osteoporosis nurses undertaking short training sessions with care home staff emphase the importance of fracture and fall prevention and train staff on how to identify those residents at high risk of fracture. Residents' risk of fracture and falls was reported to general practitioners (GPs) of patients along with treatment recommendations.


METHODS
primary outcome measures were total fractures over the past 12 months and total hip fractures over past the 12 months. Secondary outcome measures were total home falls, number of residents sustaining a fall, number of residents prescribed bisphosphonates, number of residents prescribed calcium and vitamin D and number of residents wearing hip protectors. All outcomes were measured at the care home level.


RESULTS
of the 230 care homes randomised data were collected from 209 of these containing 5,637 residents. There were no differences between the groups in the incidence rate ratios (IRRs) for total fractures (IRR = 0.94 [0.71, 1.26] P = 0.70) or total hip fractures (IRR = 0.86 [0.63, 1.18] P = 0.36). No differences were found between groups for home falls or hip protector use. A significant increase in bisphosphonate prescription was seen in the intervention group over the control group (IRR = 1.50 [1.00, 2.24] P = 0.05). Calcium and vitamin D prescription was significantly increased in the intervention group over the control group (IRR = 1.64 [1.23, 2.18] P<0.01).


CONCLUSIONS
the intervention significantly increased the prescription of bisphosphonates and calcium/vitamin D, but was not associated with a significant effect on the rate of falls or fractures.
Cox
Helen
H
University of York, Department of Health Sciences, SRB Area 4, York YO10 5DD, UK. hc18@york.ac.uk
Puffer
Suezann
S
Morton
Veronica
V
Cooper
Cyrus
C
Hodson
Jean
J
Masud
Tahir
T
Oliver
David
D
Preedy
Danielle
D
Selby
Peter
P
Stone
Mike
M
Sutcliffe
Anne
A
Torgerson
David
D
D000056:Accident Prevention / Q000379:methods; D000058:Accidental Falls / Q000517:prevention & control* / Q000706:statistics & numerical data; D000368:Aged; D000369:Aged, 80 and over; D016000:Cluster Analysis; D004506:Education, Nursing / Q000379:methods*; D005260:Female; D050723:Fractures, Bone / Q000517:prevention & control*; D006707:Homes for the Aged; D006801:Humans; D008297:Male; D009735:Nursing Homes; D009740:Nursing Staff / Q000193:education*; D011361:Professional Competence; D012016:Reference Values; D012112:Residential Facilities; D012307:Risk Factors; D012680:Sensitivity and Specificity