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Fall rates in hospital rehabilitation units after individualised patient and staff education programmes : a pragmatic , stepped-wedge , cluster-randomised controlled trial . BACKGROUND Falls are the most frequent adverse events that are reported in hospitals . We examined the effectiveness of individualised falls-prevention education for patients , supported by training and feedback for staff , delivered as a ward-level programme . METHODS Eight rehabilitation units in general hospitals in Australia participated in this stepped-wedge , cluster-randomised study , undertaken during a 50 week period . Units were randomly assigned to intervention or control groups by use of computer-generated , random allocation sequences . We included patients admitted to the unit during the study with a Mini-Mental State Examination ( MMSE ) score of more than 23/30 to receive individualised education that was based on principles of changes in health behaviour from a trained health professional , in addition to usual care . We provided information about patients ' goals , feedback about the ward environment , and perceived barriers to engagement in falls-prevention strategies to staff who were trained to support the uptake of strategies by patients . The coprimary outcome measures were patient rate of falls per 1000 patient-days and the proportion of patients who were fallers . All analyses were by intention to treat . This trial is registered with the Australian New Zealand Clinical Trials registry , number ACTRN12612000877886 ) . FINDINGS Between Jan 13 , and Dec 27 , 2013 , 3606 patients were admitted to the eight units ( n=1983 control period ; n=1623 intervention period ) . There were fewer falls ( n=196 , 7·80/1000 patient-days vs n=380 , 13·78/1000 patient-days , adjusted rate ratio 0·60 [ robust 95 % CI 0·42-0·94 ] , p=0·003 ) , injurious falls ( n=66 , 2·63/1000 patient-days vs 131 , 4·75/1000 patient-days , 0·65 [ robust 95 % CI 0·42-0·88 ] , p=0·006 ) , and fallers ( n=136 [ 8·38 % ] vs n=248 [ 12·51 % ] adjusted odds ratio 0·55 [ robust 95 % CI 0·38 to 0·81 ] , p=0·003 ) in the intervention compared with the control group . There was no significant difference in length of stay ( intervention median 11 days [ IQR 7-19 ] , control 10 days [ 6-18 ] ) . INTERPRETATION Individualised patient education programmes combined with training and feedback to staff added to usual care reduces the rates of falls and injurious falls in older patients in rehabilitation hospital-units . FUNDING State Health Research Advisory Council , Department of Health , Government of Western Australia .
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Intervention_Educational
individualised patient and staff education programmes :
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Intervention_Educational
individualised falls-prevention education for patients
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Intervention_Educational
training and feedback for staff
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Intervention_Educational
control
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Intervention_Educational
individualised education
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Intervention_Educational
information about patients ' goals , feedback about the ward environment , and perceived barriers to engagement in falls-prevention strategies
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Outcome_Physical
Fall rates
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Outcome_Mental
health behaviour
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Outcome_Physical
patient rate of falls per 1000 patient-days
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Outcome_Other
proportion of patients who were fallers .
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Outcome_Physical
falls
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Outcome_Other
significant difference
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Participant_Condition
hospital rehabilitation units
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Participant_Sample-size
Eight
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Participant_Condition
Mini-Mental State Examination ( MMSE
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Participant_Sample-size
3606
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Participant_Sample-size
n=1983
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Participant_Sample-size
n=1623
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Participant_Condition
injurious falls in older patients in rehabilitation