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Objective: To determine whether the rate of falls and associated serious injuries in a hospital aged care setting can be reduced using a multistrategy prevention approach.Design,setting and participants: Three-year quality improvement project comparing data at baseline (2001) and at 2-year follow-up (2003) after interventions to reduce falls.All patients admitted to the Aged Care Services wards at Caulfield General Medical Centre,Melbourne,between January 2001 and December 2003 were included.Interventions: Multistrategy approach phased in over 3 months from September 2001 and involving data gathering,risk screening with appropriate interventions,work practice changes,environmental and equipment changes,and staff education.Main outcome measures: Total number of falls; number of falls resulting in serious injuries (fractures,head injuries,death); staff compliance with the risk assessment.Results: Over a 2-year period,there was a 19% reduction in the number of falls per 1000 occupied bed-days (OBDs) (12.5 v 10.1; P = 0.001) and a 77% reduction in the number of falls resulting in serious injuries per 1000 OBDs (0.73 v 0.17; P< 0.001).Staff compliance with completing the falls risk assessment tool increased from 42% to 70%,and 60% of staff indicated they had changed their work practices to prevent falls.Conclusion: A multistrategy falls prevention program in an aged care hospital setting produced a significant reduction in the number of falls and a marked reduction in serious fall-related injuries.Incorporating a falls prevention program into all levels of an organisation,as part of daily care,is crucial to the success and sustainability of falls prevention.