Evaluation of a falls prevention programme in an acute tertiary care hospital

Aims and objectives. To evaluate a systematic, coordinated approach to limit the severity and minimize the number of falls in an acute care hospital. Background. Patient falls are a significant cause of preventable injury and death, particularly in older patients. Best practice principles mandate that hospitals identify those patients at risk of falling and implement interventions to prevent or minimize them. Methods. A before and after design was used for the study. All patients admitted to three medical wards and a geriatric evaluation management unit were enrolled over a six‐month period. Patients’ risk of falling was assessed using a falls risk assessment tool and appropriate interventions implemented using a falls care plan. Data related to the number and severity of falls were obtained from the Australian Incident Monitoring System database used at the study site. Results. In this study, 1357 patient admissions were included. According to their risk category, 37% of patients (n = 496) were grouped as low risk (score = 1–10), 58% (n = 774) medium risk (score = 11–20) and 5% (n = 63) high risk (score = 21–33) for falls. The incidence of falls (per average occupied bed day) was eight per 1000 bed days for the study period. Compared with the same months in 2002/2003, there was a significant reduction in falls from 0·95 to 0·80 (95% CI for the difference ?0·14 to ?0·16, P < 0·001). Conclusion. We evaluated a systematic, coordinated approach to falls management that included a falls risk assessment tool and falls care plan in the acute care setting. Although a significant reduction in falls was found in this study, it could not be attributed to any specific interventions. Relevance to clinical practice. Preventing falls where possible is essential. Assessment of risk and use of appropriate interventions can reduce the incidence of falls.     

心内科住院老年病人意外跌倒的原因分析及护理对策

[目的]分析心内科住院老年病人意外跌倒的原因,探讨相应的护理对策。[方法]对照组2 056例老年病人采用心内科常规护理,观察组2 246例病人在常规护理的基础上针对老年病人跌倒的原因进行护理干预。比较两组病人跌倒发生情况。[结果]观察组病人意外跌倒发生率低于对照组(χ2=4.936,P<0.05)。[结论]对心内科老年住院病人意外跌倒危险因素进行正确评估并采取相应的护理干预措施,可减少病人意外跌倒的发生。     

Falls risk assessment, multitargeted interventions and the impact on hospital falls

There is an urgent need for inquiry to validate existing scales in the accurate assessment of falls risk. Moreover, where fall prevention projects have targeted specific risk factors of falling, such as cognitive impairment, few have measured the impact of their intervention on fall outcomes. A comparative design compared and described differences in falls data within and between two study cohorts before and after a multitargeted intervention was introduced. A cut-off score of > or = 50 using the Morse Scale was a good baseline indicator for accurate identification of fall risk and outcomes verify that the modified Morse Falls Scale, in combination with other risk factors, more accurately profiled fall risk among this population. Fall incidence among the intervention cohort did not increase significantly despite a rise in the number of hospital admissions and a significantly higher reported fall risk potential.     

Evaluation of falls by inpatients in an acute care hospital in Korea using the Morse Fall Scale

The purpose of this study was to determine the cut‐off values of the Korean version of the Morse Fall Scale (MFS‐K) that would be most useful in identifying hospitalized patients at risk of falls in an acute‐care setting in Korea. This study was conducted using the medical records of 66 patients who fell and 100 patients who did not fall (no‐fall patients) sampled from inpatients hospitalized at a tertiary acute‐care hospital in Seoul during the period from 1 January to 30 November 2009. The optimal cut‐off point for the MFS‐K was found to be 45 points, which produced an acceptable sensitivity and a fairly good specificity, negative predictive value and accuracy. The highest peak on the receiver operating characteristic curve was a cut‐off score of 45 points in the MFS‐K. Further research needs to be performed to determine the optimal cut‐off score according to subjects' conditions through daily measurement with the MFS in medical or surgical patients who are relatively homogeneous in terms of individual and disease‐related factors.     

7例患者跌倒事件原因分析与管理对策

目的减少住院患者跌倒事件发生,确保患者安全。方法回顾性分析2007年1月至2008年12月发生的7例患者跌倒事件,结合医院科室实际情况制订有效措施。结果从不同层面分析了护理人员安全意识淡漠、安全防护措施不到位、患者个体因素是导致患者跌倒事件发生的原因。制订了提高护理人员安全管理意识、改进预防跌倒管理流程、完善护理安全管理机制等有效对策。结论加强护理安全管理,改进管理流程,可以确保护理安全。     

老年医院预防患者跌倒管理流程建立与应用

目的:通过建立与实施预防患者跌倒管理流程,探讨控制老年住院患者跌倒发生率的有效方法。方法:对病区住院患者实施预防跌倒管理流程,主要内容包括入院评估、签署"预防跌倒告知单"、高危警示标识的应用、针对高危因素采取有效预防措施、强化对患者及家属进行健康教育及不良住院环境的改善等。结果:实施预防患者跌倒管理流程可降低跌倒发生率,有助于建立合作性护患关系,提高患者的依从性,减少了医疗纠纷的发生。     

Relationship between call light use and response time and inpatient falls in acute care settings

Aims and objectives. This exploratory study used archived hospital data to determine whether the call light use rate and the average call light response time contribute to the fall and the injurious fall rates in acute care settings. Background. Inpatients often use call lights to seek nurses’ attention and assistance. Although implied in patient safety, no studies have examined data related to the call light use or the response time to call lights collected via existing tracking mechanisms to monitor nursing practice. Design. The study was conducted in a Michigan community hospital and used archived hospital data for analyses for the period from February 2007–June 2008. The unit of analysis was unit‐week. Method. The call light use rate per patient‐day was calculated based on information retrieved from the call light tracking system. The average response time in seconds was used as generated from the tracking system. The fall and injurious fall rates per 1000 patient‐days were calculated based on the fall incident reports. spss was used for data analyses. One‐way anova and correlation analyses were conducted. Results. More calls for assistance related to less fall‐related patient harm. Surprisingly, longer response time to call lights also related to fewer total falls and less fall‐related patient harm. Generally speaking, more call light use related to longer response times. Conclusions. This study’s findings challenged the appropriateness of targeting the goals of reducing the frequency of call light use and the fall rates as two outcome indicators of conducting hourly patient rounds. Relevance to clinical practice. Encouraging call light use is a key to reducing injurious fall rates. Unit managers should routinely monitor the trend of the call light use rate and ensure that the call light use rate is maintained at least above the mean rate.     

住院老年病人跌倒因素分析与护理对策

对10例住院老年病人跌倒因素进行回顾分析,结果表明:病人高龄、体能状态差,患有慢性疾病,不良的外界环境,镇静安眠药物的不良反应,改变体位时陪人照顾不当等因素均为造成住院老年病人跌倒的因素。为了减少或避免老年病人跌倒的发生,采用老年人不安全因素评估表等护理措施,降低跌倒发生率,创造安全、舒适的就医环境。     

住院患者跌伤评估方法的应用及效果评价

目的探讨住院患者跌伤评估方法及预防跌伤的措施。方法采用自制跌伤危险性评估表对实验组456例住院患者进行评估,同时采取预防跌伤的护理措施。并以346例住院患者作为对照组,比较两组患者跌伤知晓率、防范意识及跌伤发生率。结果实验组患者的跌伤知晓率和防范意识明显高于对照组(P=0.000),两组患者跌伤发生率差异具有统计学意义(P=0.046)。结论对住院患者进行跌伤危险性评估并采取相应的护理措施可有效预防跌伤的发生。     

Striving to prevent falls in an acute care setting — action to enhance quality

• ? Although most falls do not result in serious physical injury, they can contribute to a loss of confidence and mobility which can culminate in a significant reduction in quality of life. Furthermore, the potential to fall is often increased when an individual is institutionalized because of frailty or confusion.
• ? The purpose of the study was, therefore, to establish whether a structured intervention would assist in preventing falls in an acute setting.
• ? This pre-test/post-test study was carried out over a 12-month period. Interventions included risk assessment, an alert system, reinforcing preventive actions, staff education and ongoing audits and feedback. Initial analysis of the data and comparison of fall rates indicated a significant reduction in the rate of falls between the pre- and post-intervention phases, although subsequent statistical analysis did not identify any significant relationships.
• ? It must be noted that no controls existed for extraneous variables, although patient profiles varied minimally during the period of the study.
• ? Outcomes include: a reduction in fall numbers and rates, enhanced staff morale with ownership of the programme, provision of a learning experience for staff (on which to build), and the fostering of a professional approach to improving the quality of patient care.

     

139例住院患者跌倒不良事件分析

目的回顾性分析住院患者跌倒不良事件的临床特点,为制定有效的跌倒预防策略提供参考依据。方法通过医院护理管理平台收集2015年1月—2018年12月发生的139例跌倒护理不良事件的临床资料,统计分析相关数据。结果跌倒患者以老年人为主,占64.03%(89/139);发生跌倒次数最多的地点是卫生间,占54.67%(76/139);跌倒高发时间段为清晨(6:00~8:00)和午夜(0:00^-2:00);患者跌倒发生时当班护士以低年资护士为主;患有肿瘤相关疾病、心脑血管疾病及内分泌、代谢疾病的患者跌倒发生率高于其他基础病患者。跌倒评估不够准确/未能识别高危人群、高危患者无防控措施、患者依从性差、护士健康宣教不到位以及环境因素是导致住院患者跌倒的常见根本原因。结论护理管理者及临床护理人员,应关注跌倒不良事件的高危人群、高发地点及时间段等,实施预见性护理,从而预防跌倒的发生。     

急性脑卒中患者医院感染原因分析与护理对策

目的：探讨急性脑卒中患者医院感染发生率及危险因素,以采取有效的护理对策。方法：回顾分析404例急性脑卒中患者的病历资料,并设对照组进行比较分析。结果：本组急性脑卒中患者发生医院感染68例（84例次）,医院感染发生率为16．83％,例次感染率为20．79％;感染部位以下呼吸道、泌尿道、上呼吸道为主,构成比分别为38．10％、30．95％、19．05％,感染组、非感染组在侵入性操作、年龄、住院日方面进行比较,两组均存在显著性差异。结论：急性脑卒中患者为医院感染的高危人群,侵入性操作、不合理应用抗生素为主要易感因素。     

Evaluation of a health service delivery intervention to promote falls prevention in older people across the care continuum

Rationale, aims and objectives The incidence of falls and fall‐related injuries in older age is predicted to increase concomitantly with global population ageing, representing a serious challenge to health care systems. In spite of the availability of policy and practice guidelines for the prevention of falls and fall‐related injuries, a considerable gap remains between best practice and current health service delivery. This paper describes the method and results of the implementation and evaluation of a state‐wide workforce enhancement strategy to promote the uptake of evidence‐based falls prevention activities for older people. Methods The project was undertaken in Queensland, Australia in 2008 across the community, acute and residential aged care sectors. Six Falls Safety Officers (FSOs) were appointed to implement a 1‐year pilot of strategies aimed at enhancing workforce capacity to deliver a coordinated approach to falls prevention across the care continuum. The project was independently evaluated for process, impact and outcome. Both quantitative and qualitative data were extracted from records maintained by the FSOs for the evaluation and additional data were obtained from interviews with key stakeholders. Results Considerable progress was achieved towards the project's objectives, including the wide dissemination of information and resources, as well as the establishment of working groups to continue falls prevention planning and implementation. Barriers and facilitators to the project's implementation were identified. Conclusion The formal evaluation provides evidence for the development of a cross‐continuum service delivery model for implementing coordinated state‐wide falls prevention strategies for the prevention of falls in older people.     

老年心血管疾病患者预防跌倒的方法与效果

目的预防老年住院心血管疾病患者跌倒的发生。方法探讨适用于老年心血管疾病患者预防跌倒的方法,对护士进行系统化培训及预防患者跌倒的安全教育,制订专科特点评估表格。在评估危险因素的基础上制订针对性预防措施,并进行三级质量控制。结果提高了护士预防跌倒知识的掌握,规范了防范态度及预防护理行为(P0.01或P0.05);降低了患者跌倒发生率,提高了患者满意度度(P0.05)。结论实施预防措施可以预防老年心血管疾病患者跌倒发生率、保障患者安全。     

住院老年人跌倒的筛查方法

目的建立预测住院老年人跌倒的评估方案并进行有效干预,降低跌倒的发生率,为制定相应的干预措施提供科学依据。方法随机抽取82例75岁以上的老年住院患者,分为跌倒组与非跌倒组,进行脑卒中史、轻微精神状态检查（MMSE）、起立行走测试、精神药物应用、血甲状旁腺激素（PTH）测定等危险因素的评估并进行统计分析。结果跌倒组55例患者MMSE检查、起立行走测试结果较非跌倒组有明显统计学差异（P〈0．05）。结论老年人跌倒是一个严重的公共卫生问题,与许多因素相关。老年人跌倒的干预和预防需要着重于跌倒的高危人群,MMSE检查、起立行走测试对于发现高危人群有重要意义,可以作为跌倒的初步筛查方法。     

住院精神病患者跌倒风险管理的效果观察

目的 ：探讨跌倒风险管理对预防住院精神病患者跌倒及减轻跌倒造成伤害的影响。方法 ：将2011年7月至2013年7月的4647例精神病患者作为观察组,运用跌倒风险管理理念和方法,并与作为对照组的2009年6月至2011年6月的4504例精神病患者进行比较。结果 ：两组患者跌倒Ⅰ级、Ⅱ级、Ⅲ级伤害程度、无伤害跌倒事件上报率、跌倒风险管理依从性比较,差异有统计学意义;两组跌倒发生率比较,差异无统计学意义;观察组无护理投诉及护理纠纷,对照组有1例因为跌倒引起纠纷,通过经济赔偿解决。结论 ：对住院精神病患者进行跌倒风险管理,既可提高护理人员的质量意识、风险意识及防范跌倒风险的能力,又能促进患者参与预防跌倒管理,有效降低和减轻跌倒造成的严重伤害,提高护理质量,保障患者安全。