Magnet children's hospitals: leading knowledge development and quality standards for inpatient pediatric fall prevention programs

Magnet hospitals are required to monitor nursing-sensitive indicators and be above the mean/median of national benchmarks for those indicators. When there is no valid national benchmark, as is the case for most of the pediatric indicators, a hospital seeking Magnet designation or redesignation is charged with taking a leadership role in developing a mechanism that leads to the establishment of a national benchmark for the indicator of choice. This article will present the efforts taken by Magnet Children's hospitals to establish valid pediatric screening tools and benchmark inpatient pediatric falls.     

重庆市40家二级医院病人跌倒的调查

目的了解重庆市二级医院病人跌倒及其相关情况。方法就2008年病人跌倒情况现场问卷调查重庆市40家二级医院的护理部主任、护士长,数据收集后,采用EXCLE表进行分类统计。结果40家被调查的二级医院均有病人跌倒发生,跌倒总数达81例,其中老年病人跌倒占60．49％。81例跌倒中,有35例（43．21％）跌伤,30例（37．03％）引发医疗纠纷,16例（19．75％）导致医疗赔偿。40家医院中,仅有17家医院有跌倒防范制度并开展了病人跌倒危险度评估,所有医院均未建立病人跌倒防范团队。结论病人跌倒在重庆市二级医院中发生较普遍且以老年病人跌倒为主,病人跌倒已是导致医疗纠纷的因素之一。如何在重庆市二级医院中,开展病人跌倒危险度的评估,采取措施防范病人跌倒,值得进一步研究。     

集束化管理策略联合分级预防措施预防贫血患者跌倒的效果观察

目的 探讨集束化管理策略联合分级预防措施预防血液内科贫血患者跌倒的效果。方法 选取2016年1~12月住院的贫血患者作为观察组,选取2015年1~12月住院的贫血患者作为对照组。对照组按照常规进行风险评估及预防跌倒的健康教育,落实预防跌倒的护理措施。观察组在对照组的基础上实施集束化管理策略联合分级预防。比较2组患者跌倒率、高风险跌倒上报率。结果 患者跌倒率由0.265次/(1 000患者·d)降至0.029次/(1 000患者·d),跌倒高风险上报率由0.716次/(1 000患者·d)升至2.488次/(1 000患者·d)。结论 集束化管理策略联合分级预防能实现血液内科贫血患者预防跌倒的高效管理,能有效筛选出贫血患者中的跌倒高风险人群,降低其跌倒率,保障患者的安全。     

中国8个省份50岁及以上人群跌倒伤害及其危险因素横断面研究

目的 估计中国8个省份≥50岁人群跌倒伤害发生率和人群分布情况,分析跌倒伤害相关的生理、心理和社会危险因素。方法 WHO“全球老龄化与成人健康研究”（SAGE）中国项目第一轮横断面数据,采用两水平（个体层面和社区层面）logistic模型按城乡进行分层分析相关因素与跌倒伤害的关系。结果 本研究推算中国8个省份≥50岁老年人群中,跌倒伤害的发生率为3.2%。多元分析发现在城市地区,增龄、罹患≥3种的慢性病（OR=2.55,95% CI：1.41～4.64）可以增大跌倒伤害的发生危险;在农村地区,罹患抑郁（OR=4.33,95% CI：2.52～7.42）和罹患≥3种慢性病（OR=2.46,95% CI：1.37～4.41）也可以增大跌倒伤害的发生危险。结论 本研究提供了一个基于中国8个省份≥50岁抽样人群跌倒伤害发生率。此外,本研究还发现增龄和共患多种慢性病会增大跌倒伤害的风险,提示采取措施防止和延缓老年人群慢性病发病可能有助于降低跌倒伤害的发生的概率。     

老年内科病房实施预防跌倒分级管理方案的临床研究

目的提高住院老年患者预防跌倒的效果,降低跌倒发生率。方法应用美国约翰霍普金斯大学医院跌倒危险评估表中文版对住院老年患者进行跌倒危险性的评估,将患者分为高度、中度和低度跌倒危险并给予相应的护理措施。结果经过1年的临床研究和效果观察,某老年病房跌倒发生率由预防跌倒分级管理方案实施前0．045％下降到0．015％。结论预防跌倒分级管理方案中预防老年患者跌倒的措施针对性和可操作性较强,从而降低了跌倒发生率。     

Screening the risk of falls: a general or a specific instrument?

Aims and objectives. The aim of this study is to investigate if a general instrument (Care Dependency Scale; CDS) has the same sensitivity and specificity as a specific instrument (Hendrich Fall Risk Model; HFRM) in a screening for fall risks. Background. Falls of older patients are a common problem in hospitals. Apart from falls risk, nurses have to use many assessment tools to detect the patients’ different care problems. To decrease the workload it would be helpful to have a general instrument used as a first screening for possible risks for different healthcare problems, such as falls, instead of specific risk instruments for each individual healthcare problem. Design. A prospective design was used by measuring each patient upon admission and by registering all falls during their hospital stay. Methods. The sample consisted of 560 patients of a geriatric hospital in Germany. All of whom gave their informed consent to participate in the study. Nurses filled in the CDS and the HFRM at the time of hospital admission. Results. The CDS (cut off point ≤54) had a sensitivity of 75% (47/63 fallers) and a specificity of 46% (227/497 non‐fallers). The HFRM (cut off point ≥11) had a sensitivity of 75% (47/63 fallers) and a specificity of 47% (237/497 non‐fallers). Conclusion. The results of the CDS are similar to those of the HFRM in predicting falls. Relevance to clinical practice. The use of the CDS is preferred as it is more general and more reliable than the HFRM. The workload for nursing staff can be decreased when only one instrument is used.     

Dynamic stability in cerebral palsy during walking and running: Predictors and regulation strategies

BackgroundThe postural control in cerebral palsy (CP) is often deficient and manifests in a variety of impairments. Consequently, maintaining balance and controlling posture is impeded and results in an increased cost of locomotion and higher risk of falls.The margin of stability is an established measure to quantify dynamic stability during gait. It can be facilitated to analyze impaired control mechanisms, but it is unknown if and how people with CP manage to control the margin of stability during a more demanding motor task, such as running.Research questionHow do people with cerebral palsy regulate dynamic stability during walking and running?MethodsChildren and adolescents with bilateral cerebral palsy (N = 117; 50 female, 67 male; age 11.0 ± 3.2) were retrospectively included. All underwent instrumented 3D gait analysis, walking and running barefoot at a self-selected gait speed. People with CP were compared to a control group of N = 25 typically developed (TD). Repeated measures ANOVAs were computed to analyze group differences and multiple linear regressions to identify predictors for the medio-lateral margin of stability.ResultsThe medio-lateral margin of stability was significantly higher in the CP group and was statistically unchanged during running. Different adaptions when running were particularly observed in the lateral trunk lean and step width, which remained high in CP, whereas the TD increased the trunk lean and reduced their step width. Step width was the main predictor for the medio-lateral margin of stability in both gait conditions.SignificanceYoung people with cerebral palsy manage to maintain their medio-lateral margin of stability during walking and running, however, with significantly higher safety margins compared to typically developed. This conservative strategy may reflect an adaption to motor and postural control impairments.     

家庭医生团队服务模式对预防社区脑卒中患者跌倒的效果研究

背景　据文献报道47%的社区脑卒中患者有超过1次的跌倒，跌倒被认为是脑血管疾病的一种严重并发症。为此，加强社区脑卒中防跌倒管理已迫在眉睫。目的　探索家庭医生团队服务模式对社区脑卒中患者防跌倒的影响。方法　选取2016年在彭浦新村街道社区卫生服务中心登记的163例脑卒中患者为研究对象。采用家庭医生团队服务模式对居家脑卒中患者及照顾者进行防跌倒干预，干预时间1年。比较首次、第6个月、第12个月入户随访时脑卒中患者及其家庭照顾者防跌倒相关知识认知度、跌倒风险评估得分及2016年与2017年跌倒发生率等指标。结果　首次、第6个月、第12个月入户随访时，患者及照顾者防跌倒相关知识认知度、跌倒风险评估得分比较，差异均有统计学意义（P<0.001）；其中，第6个月、第12个月入户随访时患者及照顾者防跌倒相关知识认知度、跌倒风险评估得分均高于首次入户时，第12个月入户随访时患者及照顾者防跌倒相关知识认知度、跌倒风险评估得分均高于第6个月入户随访时（P<0.05）。2017年研究对象跌倒发生率为14.9%（24/161），低于2016年的32.5%（53/163）（χ2=13.86，P<0.01）。结论　运用家庭医生团队服务模式能有效控制社区脑卒中患者跌倒发生的风险因素，提高患者及照顾者防跌倒相关知识认知度，减少跌倒的发生率。