BackgroundFalls among hospitalised patients impose a considerable burden on health systems globally and prevention is a priority. Some patient-level interventions have been effective in reducing falls, but others have not. An alternative and promising approach to reducing inpatient falls is through the modification of the hospital physical environment and the night lighting of hospital wards is a leading candidate for investigation. In this pilot trial, we will determine the feasibility of conducting a main trial to evaluate the effects of modified night lighting on inpatient ward level fall rates. We will test also the feasibility of collecting novel forms of patient level data through a concurrent observational sub-study.Methods/designA stepped wedge, cluster randomised controlled trial will be conducted in six inpatient wards over 14 months in a metropolitan teaching hospital in Brisbane (Australia). The intervention will consist of supplementary night lighting installed across all patient rooms within study wards. The planned placement of luminaires, configurations and spectral characteristics are based on prior published research and pre-trial testing and modification. We will collect data on rates of falls on study wards (falls per 1000 patient days), the proportion of patients who fall once or more, and average length of stay. We will recruit two patients per ward per month to a concurrent observational sub-study aimed at understanding potential impacts on a range of patient sleep and mobility behaviour. The effect on the environment will be monitored with sensors to detect variation in light levels and night-time room activity. We will also collect data on possible patient-level confounders including demographics, pre-admission sleep quality, reported vision, hearing impairment and functional status.DiscussionThis pragmatic pilot trial will assess the feasibility of conducting a main trial to investigate the effects of modified night lighting on inpatient fall rates using several new methods previously untested in the context of environmental modifications and patient safety. Pilot data collected through both parts of the trial will be utilised to inform sample size calculations, trial design and final data collection methods for a subsequent main trial.Trial registrationAustralian New Zealand Clinical Trials Register (ANZCTR): ACTRN12614000615684 (cluster RCT) and ACTRN12614000616673 (observational sub-study).Date Registered: 10 June 2014 (both studies).Protocol version: 1.2 (Dated: 01 June 2014)Anticipated completion: September 2015Role of Trial Sponsor: The named sponsor for this investigator-initiated trial was the Director of the Royal Brisbane and Women’s Hospital (RBWH) Safety and Quality Unit (Therese Lee, Phone: +61 7 3646 8111). The principal investigators, SC and MA, are employed by the RBWH Safety and Quality Unit. The trial sponsor has no involvement in any aspects of study design, conduct or decision to submit the report for publication. AM and MD are employed by other departments in the sam...

Introduction: The potential of environmental assessment and modification to reduce falls has recently received attention within the gerontology literature. Research investigating the clinical effectiveness of this intervention in falls prevention reports conflicting results. Discrepancies are due to variation in the risk profile of study participants and the health care background of the person providing the environmental intervention or the intensity of the intervention provided. Method: The purpose of this paper is to compare and contrast two systematic reviews, which include meta-analyses, of environmental interventions for falls prevention in community dwelling older people, using the critical appraisal skills programme tool for systematic reviews. Findings: Both reviews found that: environmental assessment and modification was effective in falls prevention; intervention was effective with high but not low risk participants; and that high intensity environmental assessment was effective, whereas low intensity intervention was not. Environmental interventions which were delivered by occupational therapists were deemed high intensity, probably because their underpinning theoretical frameworks focus on the impact of the environment on function. Conclusion: We discuss possible reasons why occupational therapist led environmental assessment and modification is clinically effective in falls prevention, for people at high risk of falls, whereas non occupational therapist led intervention is not.

Background: Non-slip socks have been suggested as a means of preventing accidental falls due to slips. This study compared the relative slip resistance of commercially available non-slip socks with other foot conditions, namely bare feet, compression stockings and conventional socks, in order to determine any traction benefit.