Feasibility and efficacy of video-based falls prevention education for cognitively impaired hospital inpatients – a pilot study

Brief name: Educational falls prevention video Why: It was a silent video that communicated primarily with universal body language and symbols (ticks and crosses) with the aim of overcoming language barriers that were common to the culturally and linguistically diverse local geriatric population. The main message of the video is to instruct patients to ask for help if they want to get out of bed and ambulate to the toilet. Most inpatient falls in older adults occur around the bed area and in the toilet, when patients attempt to transfer and ambulate without asking for nursing assistance. The visual instruction was strengthened by the scenes of broken bones to arouse emotional memory (emotional scenes are better remembered than ordinary ones). What: Materials: 1. education video as described above 2. Computers on wheels Procedures: Investigators used computers on wheels to play the educational video to patients randomized to the intervention arm. After the video finishes playing, the investigators asked the patient what the video was about and explained the video if they didn't get the message. They asked patients to remember the video's message for the following day. Who provided: Doctors and nurses, both junior and senior, who had been briefed about this project, showed the video to patients. How: face to face education provided to individual patients Where: Bankstown-Lidcombe hospital, Sydney, NSW, Australia. Tertiary teaching hospital ~454 beds. Inpatient setting, on various wards (general medical, surgical, stroke, cardiology, acute geriatric, rehabilitation, psychogeriatric, medical assessment unit). We didn't include mental health, dialysis unit or emergency department. When and How much: The video was played once to each patient in the intervention arm. The intervention could take place any time of day between 9am to 8pm. The video was 40 seconds long, but the face to face sessions to deliver and discuss the video would take around 3 minutes. Tailoring: The procedure of showing this educational video and discussing it with patients was standardized. Patients who were unable to watch the video (e.g. blind, drowsy) were excluded from randomization. Patients who were unable to discuss the contents of the video (e.g. aphasic) were also excluded from randomisation. Non english speaking patients were included if someone was available to interpret for them (e.g. carer, professional interpreter, health care worker who speaks the same language). Modifications: Initally there was a scene in the video where the bedrail was up. Over the years, our hospital's policy changed regarding bed-rail use. This scene was subsequently changed to one with the bedrails down. This modification occurred midway through the study, after ~20 participants were enrolled How well: Intervention fidelity was not assessed. After briefing the 4 investigators about the project, they were trusted to deliver the intervention faithfully.