title: 6-PACK programme to decrease fall injuries in acute hospitals: cluster randomised controlled trial.
abstract: OBJECTIVE
  To evaluate the effect of the 6-PACK programme on falls and fall injuries in acute wards.
  
  
  METHODS
  Cluster randomised controlled trial.
  
  
  METHODS
  Six Australian hospitals.
  
  
  METHODS
  All patients admitted to 24 acute wards during the trial period.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
  
  
  BACKGROUND
  Australian New Zealand Clinical Trials Registry ACTRN12611000332921.
authors.affiliation: Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia anna.barker@monash.edu.
authors.forename: Anna L
authors.initials: AL
authors.lastname: Barker
authors.affiliation: Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia.
authors.forename: Renata T
authors.initials: RT
authors.lastname: Morello
authors.affiliation: Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia.
authors.forename: Rory
authors.initials: R
authors.lastname: Wolfe
authors.affiliation: Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia.
authors.forename: Caroline A
authors.initials: CA
authors.lastname: Brand
authors.affiliation: Physiotherapy Department, Monash University, Allied Health Research Unit, Monash Health, Kingston Centre, Cheltenham, VIC 3195, Australia.
authors.forename: Terry P
authors.initials: TP
authors.lastname: Haines
authors.affiliation: School of Physiotherapy and Exercise Science, Curtin University, Perth, WA 6102, Australia.
authors.forename: Keith D
authors.initials: KD
authors.lastname: Hill
authors.affiliation: Division of Physiotherapy, School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, QLD 4072, Australia.
authors.forename: Sandra G
authors.initials: SG
authors.lastname: Brauer
authors.affiliation: School of Nursing and Midwifery, Deakin University, Burwood, VIC 3125, Australia.
authors.forename: Mari
authors.initials: M
authors.lastname: Botti
authors.affiliation: School of Public Health, University of Sydney, Sydney, NSW 2006, Australia.
authors.forename: Robert G
authors.initials: RG
authors.lastname: Cumming
authors.affiliation: School of Nursing and Midwifery, Deakin University, Burwood, VIC 3125, Australia.
authors.forename: Patricia M
authors.initials: PM
authors.lastname: Livingston
authors.affiliation: George Institute for Global Health, Sydney Medical School, University of Sydney, Sydney, NSW 2006, Australia.
authors.forename: Catherine
authors.initials: C
authors.lastname: Sherrington
authors.affiliation: Centre for Health Economics, Monash Business School, Monash University, Clayton, VIC 3800, Australia.
authors.forename: Silva
authors.initials: S
authors.lastname: Zavarsek
authors.affiliation: George Institute for Global Health, Sydney Medical School, University of Sydney, Sydney, NSW 2006, Australia.
authors.forename: Richard I
authors.initials: RI
authors.lastname: Lindley
authors.affiliation: Northern Hospital, Northern Health, Epping, VIC 3076, Australia.
authors.forename: Jeannette
authors.initials: J
authors.lastname: Kamar
mesh_terms: D000058:Accidental Falls / Q000517:prevention & control* / Q000706:statistics & numerical data; D000368:Aged; D001291:Attitude of Health Personnel; D001315:Australia / Q000453:epidemiology; D002985:Clinical Protocols; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D018570:Risk Assessment; D014947:Wounds and Injuries / Q000453:epidemiology / Q000517:prevention & control*
references.citation: JAMA. 2010 Nov 3;304(17):1912-8
references.pmid: 21045097
references.citation: J Adv Nurs. 2011 Sep;67(9):1984-92
references.pmid: 21507049
references.citation: Cochrane Database Syst Rev. 2012;12:CD005465
references.pmid: 23235623
references.citation: Age Ageing. 2014 Mar;43(2):247-53
references.pmid: 24141253
references.citation: Int J Nurs Pract. 2001 Feb;7(1):38-45
references.pmid: 11811346
references.citation: Clin Risk. 2012 Sep;18(5):163-169
references.pmid: 23136533
references.citation: Age Ageing. 2013 Sep;42(5):633-40
references.pmid: 23868093
references.citation: Age Ageing. 2014 Jul;43(4):484-91
references.pmid: 24321841
references.citation: J Clin Epidemiol. 2004 Dec;57(12):1288-94
references.pmid: 15617955
references.citation: HIM J. 2011;40(3):5-11
references.pmid: 22006431
references.citation: BMJ. 2008 Apr 5;336(7647):758-60
references.pmid: 18332052
references.citation: Osteoporos Int. 2007 Feb;18(2):167-75
references.pmid: 17061151
references.citation: Clin Geriatr Med. 2010 Nov;26(4):645-92
references.pmid: 20934615
references.citation: JAMA Intern Med. 2015 Mar;175(3):347-54
references.pmid: 25559166
references.citation: J Am Geriatr Soc. 2010 Mar;58(3):435-41
references.pmid: 20398112
references.citation: Gerontology. 2008;54(6):342-8
references.pmid: 18460867
references.citation: Lancet. 2015 Jun 27;385(9987):2592-9
references.pmid: 25865864
references.citation: N Engl J Med. 2007 Oct 18;357(16):1573-5
references.pmid: 17942869
references.citation: Age Ageing. 2006 Jan;35(1):5-10
references.pmid: 16364930
references.citation: Jt Comm J Qual Patient Saf. 2011 Feb;37(2):81-7
references.pmid: 21939135
references.citation: Qual Saf Health Care. 2010 Dec;19(6):e51
references.pmid: 20558479
references.citation: Med Care. 2005 Nov;43(11):1130-9
references.pmid: 16224307
references.citation: Singapore Med J. 2009 Apr;50(4):425-32
references.pmid: 19421690
references.citation: J Adv Nurs. 2011 Feb;67(2):450-7
references.pmid: 21105896
references.citation: Int J Nurs Stud. 2011 Sep;48(9):1040-8
references.pmid: 21419411
references.citation: J Am Geriatr Soc. 2010 Jul;58(7):1347-52
references.pmid: 20487077
references.citation: J Gen Intern Med. 2004 Jul;19(7):732-9
references.pmid: 15209586
references.citation: Stat Med. 1993 Feb;12(3-4):329-38
references.pmid: 8456215
references.citation: J Adv Nurs. 2013 Jan;69(1):112-21
references.pmid: 22458341
references.citation: BMJ. 2004 Mar 20;328(7441):676
references.pmid: 15031238
references.citation: Med J Aust. 2015 Nov 2;203(9):367
references.pmid: 26510807
references.citation: J Am Geriatr Soc. 2013 Apr;61(4):483-94
references.pmid: 23527904
references.citation: Mt Sinai J Med. 1993 Nov;60(6):522-7
references.pmid: 8121429
references.citation: Ann Intern Med. 2012 Nov 20;157(10):692-9
references.pmid: 23165660
references.citation: J Hosp Med. 2011 Jul-Aug;6(6):313-21
references.pmid: 21834112
references.citation: JAMA Intern Med. 2015 Mar;175(3):354-5
references.pmid: 25561391
references.citation: Arch Intern Med. 2011 Mar 28;171(6):516-24
references.pmid: 21098343
references.citation: J Hosp Med. 2012 Jul-Aug;7(6):497-503
references.pmid: 22371369
references.citation: Int J Geriatr Psychiatry. 2004 Sep;19(9):858-63
references.pmid: 15352143
references.citation: Qual Saf Health Care. 2009 Dec;18(6):467-72
references.pmid: 19955459
references.citation: Int J Clin Pract. 2015 Jun;69(6):703-9
references.pmid: 25707918
references.citation: Inj Prev. 2011 Aug;17(4):e5
references.pmid: 21653650
references.citation: Gait Posture. 2014 Jan;39(1):118-23
references.pmid: 23850327
references.citation: Age Ageing. 2004 Jul;33(4):390-5
references.pmid: 15151914