What is the 6-PACK project?

Despite focused awareness programs and hospital spending, the rates of in-hospital fractures remain stagnant.

We designed a program with the potential to reduce fall injuries, using an approach with promising results from one hospital. This project evaluated this program - the 6-PACK - that aims to improve the care of older people in hospital.

The 6-PACK program is a targeted, nurse delivered, falls prevention program, designed specifically for acute hospital wards. It consists of a nurse assessment of a patient's risk, using a nine-item risk assessment tool and the delivery of one or more of the six 6-PACK interventions (including the use of low-low beds) applied to patients classified as high-risk by the tool.

The 6-PACK was designed and successfully implemented at The Northern Hospital in Victoria, as published in the British Medical Journal of Quality & Safety.  Findings from a 9-year observational study reported a sustained reduction in fall injuries following the implementation of the 6-PACK (25% in the first year following implementation and a 50% reduction in the second year, with reductions sustained for 5 years).

This research project used a cluster randomised controlled design and involved over 40,000 patients from 24 acute medical and surgical wards from a selection of hospitals across Australia.



Aims of the 6-PACK project:

1. Determining if the 6-PACK program can achieve meaningful reductions in falls injuries in hospitals other than where it was first developed.

2. Examining the introduction of the 6-PACK program from a staff perspective to improve our understanding of the difficulties in implementing new falls prevention programs.

3. Understanding an economic evaluation of the program to ascertain if implementing the 6-PACK also results in cost savings for hospitals.


Phases of the 6-PACK project

There were three main phases to the project.

Phase 1 involved baseline data collection, where falls data collected by the site data collectors were used to gain an understanding of what the current problem of falls looked like on participating wards.

  •     Commenced in September 2011
  •     26 wards from 7 hospitals
  •     Daily data was collected on more that 5,000 patients in the baseline cohort
  •     Completed in December 2011

Phase 2 is the cluster randomised control trial where wards were randomised to the 6-PACK intervention or control group. This phase ran for one year. During this time, the intervention wards implemented the 6-PACK program while the control wards continued with standard care practices.

  •     Commenced in December 2011
  •     24 wards from 6 hospitals; with half of these wards implementing the 6-PACK program
  •     Completed March 2013

Phase 3 is the sustainability phase. This phase ran for one year. During this time the researchers continued to monitor what happened to falls and fall injury rates at each of the participating hospitals after the RCT had ended.

  •     Commenced in April 2013
  •     Completed in December 2013

All three phases of the 6-PACK project are now complete. The research team will continue to analyse data and write-up publications on the multiple research avenues which have branched from this extensive project.