Resident-to-Resident Mistreatment: Evaluation of a Staff Training Program in the Reduction of Falls and Injuries.
Jeanne A Teresi, Mildred Ramírez, Terry Fulmer and 8 others
PMID 29677382WHAT IT FOUND
Training nursing-home staff to recognize and manage resident-to-resident mistreatment did not significantly reduce falls.
The estimated reduction was small and uncertain, so this is not proof the program works.
Key findings
01The staff training program did not produce a statistically significant reduction in falls.
02Among 893 residents who could self-report, 41.7% of those involved in resident-to-resident mistreatment had a fall in the past two weeks, compared with 33.6% of those not involved.
03The authors estimated a 5% net reduction, about 10.1 falls saved per year in an average 200-bed facility, but the trial was underpowered to detect effects this size.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The primary fall outcome was not statistically significant (p=0.235), so the observed reduction could be chance. The study was underpowered; detecting a 5% net endpoint difference would require 1094 to 1678 residents per group. Only four facilities provided complete data after one dropped, so results may not generalise to all nursing homes. The intervention group had slightly higher cognitive and functional impairment at baseline, although cognition was included in the model. Falls and mistreatment may have been under-reported, and the study could not identify which training component or environmental change reduced falls. The association between resident-to-resident mistreatment and falls was exploratory and relied partly on self-report and facility comparisons.
The easy way to misread this
Do not conclude that staff training significantly reduced falls. The primary fall outcome was not statistically significant (p=0.235), and the estimated 5% reduction was underpowered; the paper shows a possible association between mistreatment and falls, not proof that training prevents falls.