院内病人跌倒风险因素及其损伤分析

[目的]了解医院内病人跌倒发生高危因素,识别跌倒损伤的预测因素。[方法]采用回顾性资料分析方法,对2006年1月～2010年12月76例跌倒病人的不良事件报告资料进行分析。[结果]76例跌倒病人中,89．5％的系65岁以上的高龄病人,57．9％发生于夜班时间,46．1％发生于床旁,跌倒诱因中53．9％源于排便的生理需要;跌倒评估、跌倒场所、撞击物体是跌倒致伤的预测因素。[结论]加强老年病人上下床行为、如厕行为的健康教育,重视陪护人员预防病人跌倒胜任力的培训,进一步规范跌倒评估是预防病人跌倒的主要护理干预措施。     

住院患者跌倒风险因素及管理

住院患者院内跌倒是医院常见的不良事件。住院患者跌倒不仅导致患者受伤、病死率增加、生活质量下降和医疗费用增加,同时也给医疗带来重大负担,包括增加了住院时间、平均住院费用。跌倒常发生于老年患者,据报道,社区中有1/3的65岁以上的老年人和1/2的80岁以上的老年人1年会经历1次跌倒[1]。每年有280万老年人因跌倒损伤在急诊科就诊,占急诊科就诊人数的10%~15%[2-3]。跌倒是非致命性损伤的主要原因,2015年报道其发生率占创伤的63.8%[4],也是老年人受伤死亡的主要原因[5]。据调查,2015年跌倒的医疗费用总额超过500亿美元[6-7]。院内跌倒是指患者在院内就诊期间发生的跌倒事件。住院患者中特别老年患者,跌倒是常见事件,可能会引起患者对跌倒的恐惧,失去独立性、受伤,有时甚至因受伤而死亡。本文对住院患者院内跌倒的流行病学、风险因素及管理综述如下。     

住院患者跌倒损伤的原因分析

目的分析住院患者跌倒损伤原因,探讨减少跌倒赔偿的措施。方法回顾性分析2007--2009临床科室上报的45例跌倒事件中发生死亡、各类骨折、脑出血等严重跌倒损伤的19个案例。结果2007年跌倒发生例数12例,跌倒损伤3例,损伤率为25％;2008年跌倒发生例数15例,跌倒损伤4例,损伤率为26．26％;2009年跌倒发生例数18例,跌倒损伤12例,损伤率为66．67％。19例跌倒严重损伤患者包括1例死亡,蛛网膜下腔出血2例,各类骨折16例;3季度发生跌倒损伤10例,占总数52．63％;跌倒损伤年龄高于跌倒平均年龄3．23岁;94．74％的跌倒损伤患者患有心脑血管疾病、老年痴呆、糖尿病等原发疾病;47．37％的损伤患者跌倒时有人陪护。结论跌倒患者年龄越大越容易发生损伤;慢性疾病是加重跌倒损伤的重要因素;加强陪护人员教育培训作为降低住院患者跌倒率的重要措施;夏季衣着单薄导致跌倒损伤高发。管理者可通过对跌倒关键环节的把控,推行护理差错事件无责上报,加强护理人员及时补救能力及护士长忧患意识等途径减少跌倒赔偿。     

养老机构老年人跌倒风险的危险因素分析

目的 探讨养老机构老年人跌倒风险的危险因素。方法 2021年9月—2022年2月选取唐山市3所养老机构460名老年人为调查对象,经Morse跌倒评估量表（MFS）评定,将高跌倒风险老年人230名纳入观察组,低跌倒风险老年人230名纳入对照组,采用一般资料调查表、养老机构特征性问卷和Tilburg衰弱量表（TFI）进行评估。结果 多因素Logistic回归分析结果显示,不害怕跌倒、不使用助行器、无骨质疏松和室内无障碍物是养老机构老年人跌倒风险的保护因素（P<0.05）,慢性病种类、养老机构非医养结合、卧室无床头/脚灯、卫生间无防滑垫、无室外庭院和衰弱是养老机构老年人跌倒风险的危险因素（P<0.05）。结论 养老机构的生活服务环境是影响养老机构老年人跌倒风险的重要因素,应改善养老机构服务环境,降低跌倒风险,预防跌倒发生。     

北京市某社区老年人跌倒风险及其影响因素分析

目的:调查北京市某社区老年人跌倒风险现状,并对社区老年人跌倒风险的相关因素进行分析,为采取有效的预防和干预措施提供依据。方法:采用"跌倒风险评估量表"对北京市某社区221名老年人进行跌倒风险的评估。结果:该社区老年人跌倒风险评估量表平均得分为(28.12±7.47)分,有跌倒风险的老年人(得分≥30分者)占该人群的43.44%。性别、是否有尿频尿急等情况、是否使用助行器、是否患慢性疾病、是否进行体育锻炼、是否有跌倒史等因素与跌倒风险相关(P<0.05)。结论:该社区老年人跌倒风险较高,应针对跌倒风险的相关因素采取有效的预防和干预措施,并在今后的研究中加大对跌倒风险的评估以预防跌倒的发生。目的:调查北京市某社区老年人跌倒风险现状,并对社区老年人跌倒风险的相关因素进行分析,为采取有效的预防和干预措施提供依据。方法:采用"跌倒风险评估量表"对北京市某社区221名老年人进行跌倒风险的评估。结果:该社区老年人跌倒风险评估量表平均得分为(28.12±7.47)分,有跌倒风险的老年人(得分≥30分者)占该人群的43.44%。性别、是否有尿频尿急等情况、是否使用助行器、是否患慢性疾病、是否进行体育锻炼、是否有跌倒史等因素与跌倒风险相关(P<0.05)。结论:该社区老年人跌倒风险较高,应针对跌倒风险的相关因素采取有效的预防和干预措施,并在今后的研究中加大对跌倒风险的评估以预防跌倒的发生。     

老年脑卒中病人跌倒风险因素及预防策略研究进展

归纳老年脑卒中病人各方面跌倒的风险因素,在此基础上总结了相对应的预防策略,以期降低老年脑卒中病人跌倒发生率,提升病人生活质量。     

妇科病人意外跌倒风险因素评估及护理对策

目的 分析妇科住院病人意外跌倒的风险因素,制定预防及控制妇科病人意外跌倒的护理对策。方法 采用统计学分析方法,调查2001年1月-2003年12月妇科病人发生意外跌倒例数和相关风险因素构成比。2004年1-12月对评估伴有意外跌倒风险因素的妇科病人,实施安全护理对策,预防意外跌倒的发生。结果 实施对策后目标人群预防意外跌倒的意识加强,意外摔倒病人发生率显著性下降,P〈0．05。结论 对妇科病人是否伴有意外跌倒风险因素进行评估,并对目标人群采取安全护理对策,可有效预防妇科病人意外跌倒的发生。     

产科病区孕产妇跌倒的风险因素分析及对策

分析12例孕产妇跌倒的风险因素包括：自然分娩后或剖宫产术后卧床时间长,体位改变;产后排尿时下蹲时间久;产后出血、贫血及产程延长的产妇下床活动;孕妇患妊娠高血压疾病;产妇癫痫发作。针对上述导致孕产妇跌倒的风险因素,制定预防和控制孕产妇跌倒的护理对策：制定产科病区孕产妇跌倒风险评估内容,采用三级评估法进行风险评估;指导产妇自然分娩后或剖宫产术后早翻身,勤翻身,进行卧、坐、立的体位指导;进行产后排尿指导及下床活动指导;对患妊娠高血压疾病的孕妇及有癫痫病史的孕产妇,详细询问病史,密切观察心理及病情变化,做好患者及家属的健康宣教;做好住院期间的安全管理,如入院评估、环境安全管理,病区内制定跌倒应急预案,并组织培训、演练,护士长定期检查护理人员对跌倒风险的认识和预防措施落实情况。     

产科病区孕产妇跌倒风险因素分析与对策

目的:分析产科病区孕产妇跌倒的风险因素,制定预防孕产妇跌倒的护理对策。方法:总结分析孕产妇跌倒的相关风险因素,制定风险因素评估表,对有跌倒风险的孕产妇实施产前、产后系列护理干预,以预防孕产妇跌倒的发生。结果:实行孕产妇跌倒风险因素评估,孕产妇意外跌倒发生率较前显著下降(P<0.05)。结论:孕产妇进行跌倒风险因素评估,并根据评估结果采取积极有效的护理干预措施,可有效预防孕产妇意外跌倒的发生。     

无痛胃肠镜患者跌倒的风险因素分析及对策

目的:探讨无菌胃肠镜检查及治疗患者发生跌倒的因素,并提出相应的对策。方法:对7例行无痛胃肠镜检查及治疗患者跌倒因素进行回顾性分析。结果:不良的环境与设施、镇痛镇静药的不良反应、患者体能状态差等因素均为导致无痛胃肠镜检查患者跌倒的因素。结论:改善不良的环境、加强检查前评估、检查中检查后的观察及安全护理措施等,可预防和控制行无痛胃肠镜检查及治疗患者发生跌倒,为患者创造安全的就医环境。     

The extrinsic risk factors for inpatient falls in hospital patient rooms

This exploratory study identified the extrinsic risk factors for inpatient falls in hospital rooms both from incident reports and from nurse and nursing attendant interviews. An attributional theory of success and failure was adopted, and a proposed typology was used to elicit data, including 3 dimensions as follows: (a) patient room setting and design, (b) hospital equipment, and (c) manpower concerns.     

Recognize risk factors to prevent patient falls.

Nurse leaders can reduce the rate of falls and injuries resulting from falls by instituting a fall prevention program. This article describes how one hospital developed a successful program.     

Incidence and risk factors of hospital falls on long-term care wards in Japan

Rationale, aims and objective Falls among hospitalized patients are an important patient safety issue. In particular, the incidence of falls and risk of related injuries among the elderly are particularly high. Because the epidemiology of falls is not well scrutinized in Japanese long‐term care wards, we evaluated the incidence and risk factors of falls in this setting. Methods A prospective cohort study was conducted on long‐term care wards with 160 beds in a general hospital in Japan. All patients admitted to the wards over 25 months were enrolled and followed until discharge. The baseline characteristics and incidences of falls were measured. Results We enrolled 2973 patients with a mean age of 74 years, and median length of stay was 36 days. During the study period, 657 falls occurred in 411 (14%) patients. The incidence of falls was 3.8 per 1000 patient‐days, and by 15 and 30 days after admission to the ward, 7.3% and 11.4% of patients, respectively, had fallen. Independent risk factors related to falls during hospitalization were advanced age [≥70 years, hazard ratio (HR) 1.5, 95% confidence interval (CI) 1.2–2.0], history of falls (HR 1.2, 95% CI 1.0–1.5), frequent urination (HR 1.4, 95% CI 1.0–1.8) and requirement for toileting assistance (HR 1.4, 95% CI 1.1–1.8). Among patients who fell during the study period, 23% sustained an injury. Conclusions Many patients on long‐term care wards in Japan were elderly and experienced falls during their hospital stay, with consequent injuries. Taking into account the risk factors identified, we need to devise effective strategies to prevent falls and related injuries.     

Predictive risk factors associated with stroke patient falls in acute care settings

The purpose of this retrospective prediction study was to evaluate potential risk factors for falls in stroke patients in the acute care setting. Charts of 202 stroke patients who experienced falls and 111 stroke patients who did not fall (N = 313) were sampled from two major medical centers in the southwestern United States. Independent variables included: demographics; side of stroke; mental, motor and sensory status; activity level ordered; medications and laboratory values. A 16-variable multiple linear regression risk-factor equation resulted in r2 = .300, a highly predictive finding (F[16,296] = 7.92, p less than .001). Final results indicate that stroke patients with a history of falls, with impaired decision-making ability, that exhibit restlessness, generalized weakness, abnormal hematocrit and are easily fatigued should be identified for surveillance, especially at night when most falls occur.     

三级医院住院患者跌倒与坠床相关因素分析

目的 探讨住院患者在院期间跌倒和坠床的高发因素,以便采取有效措施减少此类事件的发生.方法 采用回顾性研究,对跌倒、坠床的各因素进行统计学分析.结果 住院病人不同年龄段的跌倒、坠床例数存在集中趋势,跌倒、坠床病人年龄集中点为73岁,高峰年龄为57～90岁;跌倒、坠床时间无时点集中趋势,男患者、无陪人患者发生此类事件机率大.结论 对住院患者跌倒和坠床高发因素的研究,对减少此类事件的发生有指导意义.     

Nurse staffing and patient falls on acute care hospital units

Changes in health care financing, beginning in the 1980's, resulted in reduced nurse staffing and skill levels in acute care hospitals. Research has shown that reduced nurse staffing has endangered some aspects of patient safety. This study estimated the relationship between three aspects of nurse staffing and the patient fall rate for four types of acute care units. The association was estimated using a generalized linear mixed model with data for 2002 from 1751 hospital units in the National Database of Nursing Quality Indicators. Higher fall rates were associated with fewer nursing hours per patient day and a lower percentage of registered nurses, although the relationship varied by unit type. Smaller hospitals also had higher fall rates. Information on unit type and different aspects of nurse staffing, with advanced statistical modeling, resulted in a more precise understanding of the relationship between nurse staffing and falls.