住院患者跌倒与坠床相关因素及防范对策的探讨

目的分析全院住院患者发生跌倒与坠床的相关因素,提出防范对策。方法对2014年1月至2014年12月全院23例住院患者跌倒与坠床的临床资料进行回顾性分析。结果造成患者跌倒与坠床的相关因素有:疾病因素、年龄因素、药物因素、环境因素、心理因素、护士因素及管理因素。结论健全护理安全管理质量组织,增强护理人员和患者的安全防范意识,对住院患者实施跌倒、坠床风险评估,重视高危患者的防护,及时向患者及家属进行宣教,同时加强环境及设施的维护,从源头上预防,可有效避免跌倒坠床事件的发生。     

心内科老年住院患者护理安全隐患及对策

目的：探讨分析心内科老年住院患者跌倒隐患并制定相关护理对策。方法：将患者分为实验组与对照组,对照组采取传统方法,大于65岁,要求患者卧床休息,并进行安全宣教。实验组同对照组方法,然后对每位住院患者进行跌倒危险因素评估,对于跌倒危险因素评估≥10分,床尾设立防跌倒标识,加强宣教及管理。结果：对照组6例发生跌倒,实验组无一例发生。两组相比,差异有统计学意义（P〈0.05）。结论：进行跌倒危险因素评估,使每位护士能关注高危患者,及时给于有效的护理方法,可以减少跌倒发生,减轻患者痛苦提高患者满意度。目的：探讨分析心内科老年住院患者跌倒隐患并制定相关护理对策。方法：将患者分为实验组与对照组,对照组采取传统方法,大于65岁,要求患者卧床休息,并进行安全宣教。实验组同对照组方法,然后对每位住院患者进行跌倒危险因素评估,对于跌倒危险因素评估≥10分,床尾设立防跌倒标识,加强宣教及管理。结果：对照组6例发生跌倒,实验组无一例发生。两组相比,差异有统计学意义（P〈0.05）。结论：进行跌倒危险因素评估,使每位护士能关注高危患者,及时给于有效的护理方法,可以减少跌倒发生,减轻患者痛苦提高患者满意度。     

精神科73例住院患者跌倒事件的分析及护理干预

目的探讨预防精神科住院患者跌倒的有效护理干预措施,提高精神科患者住院护理安全性。方法对73例精神科住院患者发生医院内跌倒的患者年龄、跌倒的时间、地点、原因、后果进行分析,制定相应的护理干预措施。结果 60岁以上的老年精神病患者是跌倒的高危人群;4:00至8:00、12:00至16:00是跌倒发生的高峰时段;跌倒的地点主要在卫生间、床旁、浴室;跌倒发生的原因主要与护理人员因素、环境因素、疾病因素、药物因素有关。结论要加强护理安全管理,改进护理流程,提高精神科患者的住院安全。     

107例住院患者跌倒原因分析

目的通过107例住院患者跌倒原因的分析,为住院患者防跌倒工作提供参考依据。方法采取根本原因分析法(RCA)分析住院跌倒患者所在护理片区、年龄、跌倒时间、地点、疾病、陪护情况及损伤程度构成比。结果内科、脑系科及老年科是全院跌倒的高发片区,占全院75.70%;发生跌倒的患者年龄≥60岁的占81.31%;跌倒高发时段为夜间(47.66%);病房及洗手间为主要跌倒区域;发生跌倒患者的疾病以脑梗塞、高血压、冠心病、糖尿病为主,占47.67%;在跌倒患者中有陪护的占71.96%;一级损伤占49.35%。结论住院患者发生跌倒的主要原因与患者疾病、年龄、用药,医护人员风险评估不足,环境,管理及陪护因素有密切关系。     

厦门某综合性三级甲等医院住院患者跌倒影响因素回顾性分析

目的 分析厦门市某综合性三甲医院不同类型跌倒患者的特征,为该地区在院患者跌倒预防的护理程序提供一定的理论依据。方法 通过医院不良事件信息系统及电子病历系统,回顾性分析2018年1月1日—2019年12月31日之间的161例院内跌倒事件,通过影响跌倒发生的因素及跌倒的表现特征、伤害程度等进行相关的对比及分析。结果 住院期间发生跌倒的患者在不同年龄段,不同时间段发生跌倒的差异有统计学意义,P<0.05,且不同年龄段跌倒后的伤害程度的差异有统计学意义,P <0.05。结论 跌倒多发生在中老年合并基础疾病的患者中,夜间如厕时发生率最高。低年龄段患者跌倒时多伴有乏力,高年龄段患者跌倒时多伴有晕厥,且年龄越大,跌倒时的伤害越严重,住院时间越长。因此应加强此类患者及家属的宣教,同时加强夜班护士对于此类患者的关注。     

运用六西格玛提高跌倒高危患者预防跌倒知晓值研究

目的：探讨一种高效、稳定的宣教方法,建立提高跌倒高危人群防范跌倒知晓值的标准化服务流程,从而有效地预防跌倒的发生。方法：应用六西格玛质量管理体系中的定义、测量、分析、改进和控制五个步骤对跌倒高危患者预防跌倒宣教流程进行分析,找出影响患者预防跌倒知晓值的主要原因,制定改进措施,并对改进前后的知晓值进行比较。结果：经过半年的实施,跌倒高危患者预防跌倒知晓值从原来的平均50.72分提高到71.70分。结论：提高跌倒高危患者预防跌倒知晓值以下措施是行之有效的：①建立跌倒高危患者交接班制度;②建立宣教后的确认制度;③增加宣教次数及累计时间;④建立护理部、护士长、责任护士预防跌倒的三级监控制度。     

内科住院病人跌倒危险因素与护理干预

目的:探讨分析内科住院患者跌倒原因,并根据影响因素制定护理对策,为患者提供安全保障.方法:从2014年6月—2016年6月期间我院神经内科住院患者中随机选取100例作为研究对象,对患者的临床资料进行回顾性分析,研究其发生跌倒的影响因素,并针对性的制定护理干预措施.结果:引起内科住院患者发生跌倒的主要因素有患者性别年龄因素、疾病因素、药物因素、环境因素、时间因素及患者自身心理因素等.结论:护理人员可选择针对性的护理方式,加强巡视及交接班管理,并定期进行健康教育,提升护理质量,以减少临床中住院患者跌倒发生概率.     

住院患者跌倒原因分析及护理对策

目的分析住院患者发生跌倒的原因及特点,探讨如何预防跌倒事件的发生。方法对20例跌倒的患者进行回顾性分析,分析跌倒发生的原因。结果发生跌倒的患者平均年龄72.5岁,年龄≥65岁的占80%;男性患者占60%,女性患者占40%;在卫生间或卫生间门口跌倒的占35%;发生跌倒的患者原发病前三位为肾功能衰竭尿毒症期、脑梗塞、晚期肿瘤;患者跌倒时陪护不到位达100%;易发生跌倒的时间为2：00-6：00和16：00-18：00两个时段,患者跌倒前行为40%是想上厕所。患者跌倒的主要原因与护士缺乏对夜间跌倒注意事项及对患者有针对性、个性化的预防跌倒措施宣教有关,也与跌倒高危患者对自身体能评估不足、陪护安全意识不强、防护措施不完善等有关。结论加强护士对患者夜间跌倒事件的预防培训,让患者及陪护重视预防跌倒的重要性,加强个性化健康教育,加强陪护管理,从而预防跌倒事件的发生。     

康复病人夜间跌倒坠床的因素分析与护理对策

目的 分析康复科病人夜间跌倒坠床的相关性因素,探讨有效的护理对策.方法 对我院发生的夜间跌倒事件进行回顾性分析.结果 夜间坠床跌倒事件与患者、陪护、值班护士以及护理管理等因素相关.结论 通过对夜间坠床跌倒原因的分析,提醒值班医护人员加强病人住院安全管理,减少跌倒发生率,保障患者住院安全.     

如何预防住院患者跌倒

建立并实施高危跌倒筛查,对跌倒高危患者实施预防跌倒护理措施,发放预防跌倒宣教单,护士长每天对高危跌倒患者进行重点查房等,作者所在科室住院患者跌倒发生率明显降低,护理人员预防跌倒的意识提高,证明住院患者跌倒可以预防。     

Epidemiologische Analyse von Sturzunfällen im Kindesalter (<15 Jahre) Konsequenzen für die Prävention

In Germany, the database on falls among children (<15 years) is insufficient because there is no systematic, population-based monitoring of injuries according to location, type and mechanism. This analysis will compile relevant data on fall injuries among children in Germany and define risk groups, risk factors and typical accident mechanisms according to the frequency and severity of fall injuries. Results: In 1998, 31 children (<15 years) (N=655) died through falls, in most cases by falling from a building (n=8). Around 700,000 children are estimated to have required medical treatment for falls, approx. 120,000 of them being hospitalized. Fall injuries show an age- and environment-specific accident pattern. Most of the falls among infants and toddlers are from changing tables, children's beds, high chairs and stairs. Among school-age children, falls occur most frequently at school (during break and physical education lessons) and during leisure activities (skating, cycling). These facts should form the basis for prevention measures targeting behaviour and health conditions.     

抗菌药物引起二重感染51例报道

目的 分析引起二重感染的．原因，促进抗菌药物的合理使用。方法 对我院2001年1～6月部分住院患者(51例)住院期间发生的二重感染进行了回顾性研究，对患者年龄、原发疾病、住院天数、细菌培养结果、抗菌药物应用情况和二重感染部位和类型统计分析。结果 结果表明高龄、严重的原发疾病、长期联合使用抗菌药物尤其是广谱抗菌药物、长期住院等是引起二重感染的主要原因。结论 对高危患者临床用药过程中应注意合理选择抗菌药物及适当的给药方案，并观察患者的临床表现，以减少二重感染的发生。     

Do proxies reflect patients' health concerns about urinary incontinence and gait problems?

Background

While falls and urinary incontinence are prevalent among older patients, who sometimes rely on proxies to provide their health information, the validity of proxy reports of concern about falls and urinary incontinence remains unknown.

Methods

Telephone interviews with 43 consecutive patients with falls or fear of falling and/or bothersome urinary incontinence and their proxies chosen by patients as most knowledgeable about their health. The questionnaire included items derived from the Medical Outcomes Study Short Form 12 (SF-12), a scale assessing concerns about urinary incontinence (UI), and a measure of fear of falling, the Falls Efficacy Scale (FES). Scores were estimated using items asking the proxy perspective (6 items from the SF-12, 10 items from a UI scale, and all 10 FES items). Proxy and patient scores were compared using intraclass correlation coefficients (ICC, one-way model). Variables associated with absolute agreement between patients and proxies were explored.

Results

Patients had a mean age of 81 years (range 75–93) and 67% were female while proxies had a mean age of 70 (range 42–87) and 49% were female. ICCs were 0.63 for the SF-12, 0.52 for the UI scale, and 0.29 for the FES. Proxies tended to understate patients' general health and incontinence concern, but overstate patients' concern about falling. Proxies who lived with patients and those who more often see patients more closely reflected patient FES scores compared to those who lived apart or those who saw patients less often. Internal consistency reliability of proxy responses was 0.62 for the SF-12, 0.86 for the I-QOL, and 0.93 for the FES. In addition, construct validity of the proxy FES scale was supported by greater proxy-perceived fear of falling for patients who received medical care after a fall during the past 12 months (p < .05).

Conclusion

Caution should be exercised when using proxies as a source of information about older patients' health perceptions. Questions asking about proxies' views yield suboptimal agreement with patient responses. However, proxy scales of UI and fall concern are internally consistent and may provide valid independent information.     

分级诊疗制度下考虑患者偏好的医疗服务资源纵向整合研究

分级诊疗制度是现阶段改善患者无序就医、合理配置医疗资源、促进基本医疗服务均等化的重要举措。本文界定了个人可支配收入、年龄、自感疾病严重程度及医疗机构门诊价格、服务容量等多因素影响的患者理性就医行为的效用函数,构建了基于患者就医偏好的就医选择动态博弈模型,通过将理性就医偏好下虚拟行动仿真的秦皇岛医疗机构患者分布与实际统计数据进行比较,验证了所建模型的合理性。研究结果表明:患者在基层医疗机构与高水平医疗机构间的就医行为较理性,在二三级医院间却较不理性。因而分级诊疗制度下医疗服务资源优化的重点在于建立患者按需就医的整合型医疗服务体系。     

Smoking Cessation Experiences of Chronic Lung Disease Patients Living in Rural and Urban Areas of Virginia

Abstract Rural residents differ from individuals living in urban areas in their views about health and health behavior, their socioeconomic status, and their access to health care services. Such differences may have implications for health policy and the focus and design of health care services, including educational interventions. This paper reports findings from a comparative analysis of rural and urban chronic obstructive pulmonary disease (COPD) patients' smoking cessation experiences. The study's aims were to determine whether rural COPD patients differed from their urban counterparts in smoking patterns, smoking cessation attempts (i.e., number of quitting attempts, methods used, withdrawal symptoms, professional and personal supports for quitting smoking), and smoking cessation outcomes. Forty-eight rural and 86 urban COPD patients were interviewed by telephone using a pretested questionnaire. The rural and urban samples did not significantly differ in demographic characteristics, disease severity, functional status, smoking patterns, reasons for smoking, perceived benefits of smoking cessation, or withdrawal symptoms. However, the rural COPD patients used fewer smoking cessation methods and had fewer persons supporting their smoking cessation attempts. Rural patients' support networks for smoking cessation primarily consisted of family members, whereas those of urban patients were more varied. Similar percentages of rural and urban patients had been abstinent from smoking for at least six months at the time of the interview, controlling for age and disease severity. Logistic regressions were used to identify predictors of current smoking for the rural and urban samples. For the rural sample, less educated individuals were more likely to be current smokers. Spouse smoking predicted current smoking in the rural sample but was only marginally significant (P=0.054). In the urban sample, use of daily medication for breathing (a proxy measure of disease severity) had a significant negative effect on current smoking. Smoking due to stress was a significant positive predictor of current smoking. Findings from this exploratory study suggest the existence of rural/urban differences in COPD patients' smoking cessation patterns that warrant further investigation.     

Patients presenting to family physicians after a fall: a report from the Ambulatory Sentinel Practice Network.

BACKGROUND. Patients who fall present a diagnostic challenge to family physicians. The diagnostic workup of these patients must be thorough enough to detect and treat important causes of the fall yet not subject patients to unnecessary tests. Previous studies have provided only limited guidance for primary care physicians because in general they occurred in settings other than primary care and focused on a single age group. METHODS. The Ambulatory Sentinel Practice Network (ASPN) conducted a 6-month study of primary care patients of all ages presenting after a fall, or with medical problems resulting from a fall. ASPN clinicians collected information about the history, physical examination findings, and follow-up of these patients. Causes of falls were grouped into three categories: external reasons for falling, internal reasons related to gait, and internal reasons unrelated to gait. RESULTS. Participating clinicians identified 431 patients who had falls out of the 256,680 seen for any reason during the study period. The patients ranged in age from 1 to 94 years. The rate of falls for patients increased rapidly after age 65 years. Most falls occurred for reasons external to the patient, but internal reasons, both nonlocomotor and locomotor, increased after age 65 years. No nonlocomotor causes for a fall were found in patients younger than 65 years of age. Also, the rate of hospitalization of patients seen for falls was greater in the geriatric age group. CONCLUSIONS. The results highlight the need for further research about falls, particularly those occurring in pediatric and young adult patients. Furthermore, correcting environmental hazards and modifying gait problems in the elderly by increasing lower extremity and truncal strength could decrease the risk of falling.     

中国老年人不同严重程度跌倒风险与慢性病和睡眠的关联研究

目的 探索老年人慢性疾病和睡眠状况与不同严重程度跌倒风险之间的关联,为老年人跌倒所致伤害的预防和干预提供线索.方法 采用病例对照研究发生风险,以"中国健康与养老追踪调查项目"数据为基础,利用2011-2015年抽样调查数据,运用多因素Logistic回归分析模型分析慢性疾病和睡眠的暴露与中国老年人普通跌倒和跌倒就医发生...     

Falls in a psychiatric unit

This paper analyses the falls suffered by patients admitted in the Psychiatric Unit of the "Virgen del Camino" Hospital in the period between April 1998 and October 1999, corresponding to a total of 713 persons aged between 15 and 96 years. The aim of this paper, besides that of registering the falls, is to seek a possible relation between the fall and diverse factors such as diagnosis, treatment, age, time of day when the fall took place, the surroundings where it occurred, the autonomy of the patient and its consequences. A total of 59 falls were registered, corresponding to 36 patients who suffered falls, and it was found after analysing the different factors influencing the fall that a clear profile of the patient involved could not be established, since no clear relation was found between these factors and the fall.     

Lower Incidence of In-Hospital Falls in Patients Hospitalized in Window Beds Than Nonwindow Beds

ObjectivesComparing the incidence rate of in-hospital falls between patients hospitalized in window beds and nonwindow beds.DesignRetrospective cohort study.SettingA general hospital in Mie, Japan.ParticipantsA total of 2767 patients (mean age, 68.4 years) hospitalized in four-bedded rooms between January 2014 and December 2016.MeasuresWe identified patients' bed status (window/nonwindow) and the incidence of in-hospital falls using data on medical records and incidence reports, respectively.ResultsDuring an observation period of 25,450 person-days, 57 patients had in-hospital falls (incidence rate, 2.24/1000 person-days). Incidence rate for in-hospital falls was significantly lower in the window-bed group (n = 1273) than in the nonwindow-bed group (n = 1494) [incidence rate ratio (IRR) 0.49, 95% confidence interval (CI), 0.29, 0.84]. In the multivariable analysis adjusted for age, gender, BMI, smoking and drinking habit, surgical operation during hospitalization, and independence in daily living, the window-bed group exhibited significantly lower incidence rate for in-hospital falls than the nonwindow-bed group (IRR 0.54, 95% CI 0.32, 0.93). Sensitivity analysis excluding patients aged <60 years suggested a consistent result: incidence rate for in-hospital falls was significantly lower in the window-bed group (n = 1123) than in the nonwindow-bed group (n = 925) (IRR 0.55, 95% CI 0.31, 0.95).Conclusions and implicationsThe incidence rate of in-hospital falls was significantly lower among patients hospitalized in window beds than nonwindow beds. Hospitalization in window beds might be a novel, simple preventive option for in-hospital falls. Further large-scale, prospective, multicenter research is required.