title: The 6-PACK programme to decrease fall-related injuries in acute hospitals: protocol for a cluster randomised controlled trial.
abstract: OBJECTIVE
  In-hospital fall-related injuries are a source of personal harm, preventable hospitalisation costs, and access block through increased length of stay. Despite increased fall prevention awareness and activity over the last decade, rates of reported fall-related fractures in hospitals appear not to have decreased. This cluster randomised controlled trial (RCT) aims to determine the efficacy of the 6-PACK programme for preventing fall-related injuries, and its generalisability to other acute hospitals.
  
  
  METHODS
  24 acute medical and surgical wards from six to eight hospitals throughout Australia will be recruited for the study. Wards will be matched by type and fall-related injury rates, then randomly allocated to the 6-PACK intervention (12 wards) or usual care control group (12 wards). The 6-PACK programme includes a nine-item fall risk assessment and six nursing interventions: 'falls alert' sign; supervision of patients in the bathroom; ensuring patient's walking aids are within reach; establishment of a toileting regime; use of a low-low bed; and use of bed/chair alarm. Intervention wards will be supported by a structured implementation strategy. The primary outcomes are fall and fall-related injury rates 12 months following 6-PACK implementation.
  
  
  CONCLUSIONS
  This study will involve approximately 16,000 patients, and as such is planned to be the largest hospital fall prevention RCT to be undertaken and the first to be powered for the important outcome of fall-related injuries. If effective, there is potential to implement the programme widely as part of daily patient care in acute hospital wards where fall-related injuries are a problem.
authors.affiliation: The Centre for Research Excellence in Patient Safety, Department of Epidemiology and Preventative Medicine, Monash University, Victoria, Australia. anna.barker@monash.edu
authors.forename: Anna
authors.initials: A
authors.lastname: Barker
authors.forename: Caroline
authors.initials: C
authors.lastname: Brand
authors.forename: Terry
authors.initials: T
authors.lastname: Haines
authors.forename: Keith
authors.initials: K
authors.lastname: Hill
authors.forename: Sandy
authors.initials: S
authors.lastname: Brauer
authors.forename: Damien
authors.initials: D
authors.lastname: Jolley
authors.forename: Mari
authors.initials: M
authors.lastname: Botti
authors.forename: Robert
authors.initials: R
authors.lastname: Cumming
authors.forename: Patricia M
authors.initials: PM
authors.lastname: Livingston
authors.forename: Cathie
authors.initials: C
authors.lastname: Sherrington
authors.forename: Silva
authors.initials: S
authors.lastname: Zavarsek
authors.forename: Renata
authors.initials: R
authors.lastname: Morello
authors.forename: Jeannette
authors.initials: J
authors.lastname: Kamar
mesh_terms: D000058:Accidental Falls / Q000191:economics / Q000517:prevention & control* / Q000706:statistics & numerical data; D001291:Attitude of Health Personnel; D001315:Australia; D016000:Cluster Analysis; D006757:Hospital Units; D006760:Hospitalization; D006801:Humans; D018570:Risk Assessment / Q000191:economics / Q000592:standards*; D016896:Treatment Outcome; D014947:Wounds and Injuries / Q000191:economics / Q000517:prevention & control*