None listed
Conditions
Brief summary
Accidental falls due to slips and trips are among the most commonly reported hospital adverse events, accounting for between 20 and 40% of all incidents. Older inpatients are especially predisposed to falls due to multiple risk factors, including gait and mobility problems. Consequently, ensuring safe patient mobilisation is a central priority for inpatient fall prevention programs. Current fall prevention guidelines and best practice evidence promote the use of well-fitting closed footwear among older inpatients. Unfortunately, in acute settings, many patients do not have access to suitable footwear, due to factors such as unplanned admissions, patient oversight, or foot pathology. Due to the short average length of acute hospital stays, it can be challenging for wards to resolve patient footwear needs in a timely fashion. As a result, many Australian facilities have begun adopting the practice of providing non-slip socks (NSS) to all older admitted inpatients; yet, the value of this practice is unclear. NSS are otherwise similar to conventional socks but provide various forms of rubberised tread on the sole. Commercial providers of NSS have advanced claims of reduced fall rates after implementing an NSS strategy although reliable, controlled studies have not been undertaken. Despite a continuing lack of evidence on the effect on falls rates, usage of NSS in the state of Queensland has escalated from one facility in 2008, to >10 in 2014. Ipswich Hospital is among the few facilities where NSS are not routinely used. It is possible that NSS could be effective in reducing inpatient falls due to factors such as lower slip resistance than no or alternate footwear, acting as an alert for high risk patients and reminder to staff about falls prevention, however the diffusion of practice despite the lack of effectiveness data is a cause for increasing concern. In order to provide clear guidance to facilities on the use of NSS, reliable data is required. The primary aim of the proposed research is to investigate the effect of a pragmatic, ward-level implementation of NSS on rates of falls and fallers in an inpatient population at a regional hospital in Ipswich, Australia and understand the implementation of the intervention. The secondary aim is to evaluate the likely cost-effectiveness of this approach.
Interventions
The intervention in this study is the ward-level provision of Non Slip Socks (NSS) to admitted patients, as pragmatically implemented by ward nursing staff. The most common strategy for NSS provision across other hospital sites in Queensland surveyed prior to the project development is to provide NSS to all admitted patients. This ‘provide-all’ approach is likely to be the most potent/efficacious and least costly strategy as it would not require any additional assessment.
In the week prior to
The intervention in this study is the ward-level provision of Non Slip Socks (NSS) to admitted patients, as pragmatically implemented by ward nursing staff. The most common strategy for NSS provision across other hospital sites in Queensland surveyed prior to the project development is to provide NSS to all admitted patients. This ‘provide-all’ approach is likely to be the most potent/efficacious and least costly strategy as it would not require any additional assessment. In the week prior to the intervention phase, a 15-minute education session (made available twice a day at nursing handover) will be delivered by one of the research team providing information on the NSS and the trial. It will be up to nursing staff to make decisions regarding the provision of NSS, but our education will suggest to provide all patients with non-slip socks and to advise patients that NSS are to be worn if not wearing well fitting enclosed shoes. We anticipate that on transitioning to the intervention phase, all current patients will be provided with NSS and after that, individual wards will determine processes to ensure NSS are provided on admission, with the ability to provide a new pair to all patients when soiled beyond wear. The approaches adopted by each ward (process as prescribed by ward leadership and as carried out by clinicians) and overall usage will be monitored through periodic contact between the study project officer and ward nursing managers and other senior nursing staff. The trial will be undertaken over 6 months. In line with the stepped wedge cluster RCT design all sites will commence as control wards a with individual wards moving into an intervention state (in random order) at the starts of month 2, 3, 4, 5 and 6. This will yield 15 months of control state data and 15 months of intervention state data.
Sponsors
West Moreton Hospital and Health Service
Study design
Allocation
Randomised controlled trial
Intervention model
Other
Primary purpose
Prevention
Masking
Blinded (masking used) (Outcomes Assessor)
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
Due to the research design, all admitted patients to five 30-bed (+/-3) inpatient wards (one each of rehabilitation, general medical, acute care of the elderly wards and two surgical wards) will be included in the study. Wards that admit primarily children, obstetric patients, and those highly dependent on medical care such as intensive care will not be included.
Exclusion criteria
Patients not admitted to trial wards will not be able to participate.
Outcome results
None listed