A stepped-wedge cluster randomised controlled trial for evaluating rates of falls among inpatients in aged care rehabilitation units receiving tailored multimedia education in addition to usual care: A trial protocol
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Introduction: Falls are the most frequent adverse event reported in hospitals. Approximately 30% of in-hospital falls lead to an injury and up to 2% result in a fracture. A large randomised trial found that a trained health professional providing individualised falls prevention education to older inpatients reduced falls in a cognitively intact subgroup. This study aims to investigate whether this efficacious intervention can reduce falls and be clinically useful and cost-effective when delivered in the real-life clinical environment. Methods: A stepped-wedge cluster randomised trial will be used across eight subacute units (clusters) which will be randomised to one of four dates to start the intervention. Usual care on these units includes patient's screening, assessment and implementation of individualised falls prevention strategies, ongoing staff training and environmental strategies. Patients with better levels of cognition (Mini-Mental State Examination >23/30) will receive the individualised education from a trained health professional in addition to usual care while patient's feedback received during education sessions will be provided to unit staff. Unit staff will receive training to assist in intervention delivery and to enhance uptake of strategies by patients. Falls data will be collected by two methods: case note audit by research assistants and the hospital falls reporting system. Cluster-level data including patient's admissions, length of stay and diagnosis will be collected from hospital systems. Data will be analysed allowing for correlation of outcomes (clustering) within units.An economic analysis will be undertaken which includes an incremental cost-effectiveness analysis. Ethics and dissemination: The study was approved by The University of Notre Dame Australia Human Research Ethics Committee and local hospital ethics committees. Results: The results will be disseminated through local site networks, and future funding and delivery of falls prevention programmes within WA Health will be informed. Results will also be disseminated through peer-reviewed publications and medical conferences.
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Fall rates in hospital rehabilitation units after individualised patient and staff education programmes: A pragmatic, stepped-wedge, cluster-randomised controlled trialHill, Anne-Marie; McPhail, S.; Waldron, N.; Etherton-Beer, C.; Ingram, K.; Flicker, L.; Bulsara, M.; Haines, T. (2015)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, ...
Evaluation of the effect of patient education on rates of falls in older hospital patients: Description of a randomised controlled trialHill, Anne-Marie; Hill, Keith; Brauer, S.; Oliver, D.; Hoffmann, T.; Beer, C.; McPhail, S.; Haines, T. (2009)Background. Accidental falls by older patients in hospital are one of the most commonly reported adverse events. Falls after discharge are also common. These falls have enormous physical, psychological and social consequences ...
It promoted a positive culture around falls prevention': Staff response to a patient education programme-a qualitative evaluationHill, Anne-Marie; Waldron, N.; Francis-Coad, J.; Haines, T.; Etherton-Beer, C.; Flicker, L.; Ingram, K.; McPhail, S. (2016)Objectives: The purpose of this study was to understand how staff responded to individualised patient falls prevention education delivered as part of a cluster randomised trial, including how they perceived the education ...