Cluster randomised trial of a targeted multifactorial intervention to prevent falls among older people in hospital

Cumming, Robert G.; Sherrington, Catherine; Lord, Stephen R.; Simpson, Judy M.; Vogler, Constance; Cameron, Ian D.; Naganathan, Vasi

doi:10.1136/bmj.39499.546030.be

Cited by 184 publications

(171 citation statements)

References 19 publications

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“…It was not blinded, and the control group had fall reduction interventions instituted, as this was the hospital standard. 61 The other negative studies were small, ranging from 54 62 to 205 patients, 60 and may have insufficient power to determine a clinical significance.…”

Section: Interventionsmentioning

confidence: 99%

Inpatient Falls

Cumbler

Simpson

Rosenthal

et al. 2013

The Neurohospitalist

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In this 2 part series, analysis of the risk stratification tools that are available, definition for the scope of the problem, and potential solutions through a review of the literature are presented. A systematic review was used to identify articles for risk stratification and interventions. Three risk stratification systems are discussed, St Thomas's Risk Assessment Tool in Falling Elderly Inpatients, Morse Fall Scale, and the Hendrich Fall Risk Model. Of these scoring systems, the Hendrich Fall Risk Model is the easiest to use and score. Predominantly, multifactorial interventions are used to prevent patient falls. Education and rehabilitation are common themes in studies with statistically significant results. The second article presents a guide to implementing a quality improvement project around hospital falls. A 10-step approach to Plan-Do-Study-Act (PDSA) cycles is described. Specific examples of problems and analysis are easily applicable to any institution. Furthermore, the sustainability of interventions and targeting new areas for improvement is discussed. Although specific to falls in the hospitalized patient, the goal is to present a stepwise approach which is broadly applicable to other areas requiring quality improvement.

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Section: Interventionsmentioning

confidence: 99%

Inpatient Falls

Cumbler

Simpson

Rosenthal

et al. 2013

The Neurohospitalist

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“…Once such data were excluded, the above inclusion and exclusion criteria identified 6 primary articles for review. 9,[21][22][23][24][25] Additionally, a cluster randomized fall prevention trial in a mixed inpatient population was published by Cumming et al 26 in 2008. The study was excluded, as the participants were pooled between rehabilitation wards and acute inpatient wards, and only incomplete data were reported separately for the acute inpatient wards.…”

Section: Selected Studiesmentioning

confidence: 99%

Meta‐analysis: Multidisciplinary fall prevention strategies in the acute care inpatient population

DiBardino

Cohen

Didwania

2012

Journal of Hospital Medicine

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BACKGROUND:Inpatient falls are common adverse events that lead to inpatient injury, increased length of stay, healthcare costs, litigation, and are a focus of patient safety and healthcare quality. Fall prevention methods are currently evolving to address the problem.PURPOSE:To examine the available data evaluating multidisciplinary fall prevention strategies in the acute inpatient setting.DATA SOURCES:A complete literature search of MEDLINE, CINAHL, EMBASE and the Cochrane Library through December 2011 was used. The bibliographies of all systematic reviews and meta‐analyses were hand searched.STUDY SELECTION:Only primary research studies relating to acute care inpatient hospital multidisciplinary fall prevention were included. Selected papers were assessed for quality by 2 authors using a 20‐point scale previously used in the fall literature.DATA EXTRACTION:Each selected study was carefully hand searched by 2 authors for the purposes of data extraction. Study results, in fall rate per 1000‐patient days, and the characteristics of the interventions used were extracted for analysis.DATA SYNTHESIS:Effect sizes (odds ratios) and 95% confidence intervals were derived for individual studies and then combined across research reports using a random‐effects meta‐analysis.CONCLUSIONS:Fall prevention strategies have a significant but small effect on fall rates despite the use of complex, multidisciplinary interventions. Additional randomized trials are needed to examine the possible benefits of multidisciplinary fall prevention strategies in the acute inpatient setting. Journal of Hospital Medicine 2012; © 2012 Society of Hospital Medicine

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“…Systematic reviews of multifactorial [8,9] and single falls prevention interventions, have demonstrated reductions in falls in acute settings or within the community [10,11] . However, some large cluster randomised trials have also reported no effects of interventions within acute settings [12] . Oliver et.…”

mentioning

confidence: 99%

“…[13] emphasised that in some clinical areas, for example rehabilitation, the achievement of higher levels of physical functioning and mobility indicates increased risk of falls, referred to as 'unpreventable' falls (p. 328). Although large trials targeting acute inpatients continue to address this serious patient safety issue [12] , nurses can engage in several behaviors that have the potential to minimise falls or to reduce the severity of injury. A randomised controlled trial using a falls education intervention (of 8 hours duration) given to 374 registered nurses did find an improvement in falls knowledge.…”

mentioning

confidence: 99%

Differences in nurses’ knowledge, behavior and patient falls incidents and severity following a falls e-learning program

Johnson

Hime

Zheng

et al. 2013

JNEP

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Background: Continuing high rates of falls was a major concern to senior nurses within our health service. Researchers and educators came together to develop and evaluate an on-line falls e-learning program to increase nurses' knowledge and falls prevention behaviors and therefore reduce falls incidents and severity.Methods: Using a pre-post test design, nurses' knowledge and behaviour (N = 71) were measured prior to undertaking the education program and three months after, using the Nurses' Falls Knowledge Test and the Falls-Prevent Scale. Patient falls incidents and severity were compared for 8 months prior to and 8 months following completion of the education program.Results: Falls knowledge was high at pre (20/21 correct) and post testing (20) with no significant difference (P = .24) found. Falls prevention behaviors significantly increased from 198.5 pre-test to 211 post-test (P < .001). There was no change in rates of falls (mean falls rates per 1000 occupied bed days [OBD] were 8.9 pre and 8.8 post, hospital 1; 3.5 pre and 5.5 post; hospital 2). A reduction in the severity of falls occurred in hospital 1 but the changes were too small for significance testing. Conclusions:This e-learning falls education program has demonstrated increases in nurses' preventive falls behaviors. Although falls incidents were not reduced the best practice approaches promoted by this program are supported in national health policy and some systematic reviews. This program is being distributed to our hospitals.

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Cluster randomised trial of a targeted multifactorial intervention to prevent falls among older people in hospital

Cited by 184 publications

References 19 publications

Inpatient Falls

Inpatient Falls

Meta‐analysis: Multidisciplinary fall prevention strategies in the acute care inpatient population

Differences in nurses’ knowledge, behavior and patient falls incidents and severity following a falls e-learning program

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