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A Randomized Controlled Trial of Staff Education

Wayne A. Ray, PhD; Jo A. Taylor, RN, MPH; Anne K. Brown, OTR, MS; Patricia Gideon, RN; Kathi Hall, BS; Patrick Arbogast, PhD; Sarah Meredith, MB, BS

Arch Intern Med. 2005;165:2293-2298.

Background  Fall-related injuries, a major public health problem in long-term care, may be reduced by interventions that improve safety practices. Previous studies have shown that safety practice interventions can reduce falls; however, in long-term care these have relied heavily on external funding and staff. The aim of this study was to test whether a training program in safety practices for staff could reduce fall-related injuries in long-term care facilities.

Methods  A cluster randomization clinical trial with 112 qualifying facilities and 10 558 study residents 65 years or older and not bedridden. The intervention was an intensive 2-day safety training program with 12-month follow-up. The training program targeted living space and personal safety; wheelchairs, canes, and walkers; psychotropic medication use; and transferring and ambulation. The main outcome measure was serious fall-related injuries during the follow-up period.

Results  There was no difference in injury occurrence between the intervention and control facilities (adjusted rate ratio, 0.98; 95% confidence interval, 0.83-1.16). For residents with a prior fall in facilities with the best program compliance, there was a nonsignificant trend toward fewer injuries in the intervention group (adjusted rate ratio, 0.79; 95% confidence interval, 0.57-1.10).

Conclusion  More intensive interventions are required to prevent fall-related injuries in long-term care facilities.

Author Affiliations: Division of Pharmacoepidemiology and Center for Education and Research on Therapeutics, Department of Preventive Medicine, Vanderbilt University School of Medicine, and VA Tennessee Valley Healthcare System, Tennessee Valley Geriatric Research Education Clinical Center, Nashville. Ms Taylor is now with the Emory Center for Health in Aging, Atlanta, Ga. Dr Meredith is now with the Medical Research Council Trials Unit, London, England.

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