流程管理在老年患者跌倒预防中的应用

目的 规范预防老年患者跌倒的管理,降低老年患者跌倒发生率.方法 制订跌倒风险评估及监控流程,组织"跌倒流程管理知识"培训并进行质量监控.结果 提高了老年患者高危跌倒预报率(P<0.01);降低了跌倒发生率(P<0.01).结论 对跌倒高危患者实施流程管理能提高跌倒预防效果,降低跌倒发生率.     

外科跌倒高危患者跟踪评估监控流程的应用与效果

目的评价应用外科住院患者跌倒流程管理降低跌倒发生率的效果。方法将跌倒高危患者跟踪评估监控流程应用于外科临床并进行动态管理,比较流程实施前（2009年）和实施后（2010年）外科高危跌倒预报率和跌倒发生率。结果2009年的预报率为0．5479％,2010年的预报率为1．5842％,差异有统计学意义（x。=17．8252,P〈0．01）;2009年跌倒发生率为0．2307％,2010年跌倒发生率为0．0278％,差异有统计学意义（）（2=4．2306,P〈0．05）。结论跌倒高危患者跟踪评估监控流程能提高外科跌倒高危预报率,降低跌倒发生率,能有效预防外科住院患者跌倒的发生。     

住院患者的防跌倒安全管理

总结住院患者的防跌倒安全管理。制定易跌倒患者评估监控制度及措施,包括:患者入院后跌倒风险评估,预防高危患者跌倒措施,高危患者跟踪、评估、监控,实施跌倒应急预案。经1年实施,住院患者跌倒的发生率由0.55%降至0.12%,保障了住院患者的安全。     

防跌倒管理流程在临床护理中的应用

目的建立和应用防跌倒管理流程,最大限度地降低住院患者跌倒的发生率。方法成立防跌倒管理小组,对护理人员培训;制定跌倒高危因素评估表;制定及实施防跌倒管理流程;每月进行质量考评。结果实施流程6月,住院患者跌倒率由实施前0.59%降至0.07%。结论实施防跌倒管理流程能降低住院患者跌倒的发生率。     

对住院患者实施跌倒风险评估和干预的效果研究

目的建立跌倒风险评估制度,降低住院患者跌倒的发生率。方法2005年开始建立并实施高危跌倒筛查、高危跌倒预报、护理干预的跌倒风险评估制度,并比较实施跌倒风险评估制度前后住院患者的跌倒发生情况。结果实施跌倒风险评估制度后,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。结论跌倒风险评估制度的实施能有效降低住院患者跌倒的发生率。     

对住院患者实施跌倒风险评估和干预的效果研究

目的 建立跌倒风险评估制度,降低住院患者跌倒的发生率.方法 2005年开始建立并实施高危跌倒筛查、高危跌倒预报、护理干预的跌倒风险评估制度,并比较实施跌倒风险评估制度前后住院患者的跌倒发生情况.结果 实施跌倒风险评估制度后,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. 结论跌倒风险评估制度的实施能有效降低住院患者跌倒的发生率.     

预防骨科患者跌倒的流程管理

目的 探讨流程管理在预防骨科患者跌倒中的实施效果.方法 成立骨科预防跌倒流程管理小组,全科护士讨论、分析骨科患者跌倒预防中存在的问题,制定预防跌倒管理流程并进行实施与监控.比较实施预防跌倒管理流程前(2008年1-12月)和实施后(2009年1-12月)跌倒发生率.结果 预防跌倒管理流程实施前发生跌倒10例,发生率1.4%;预防跌倒管理流程实施后发生跌倒1例,发生率为0.1%.实施预防跌倒流程管理前后跌倒发生率经x2检验,x2=6.7123,P<0.01,差异有统计学意义.结论 预防跌倒流程管理的实施,提高了护士对患者意外跌倒的安全关注意识,减少了跌倒高危人群意外跌倒的发生.     

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。     

失效模式与效应分析在预防住院结核病患者跌倒中的应用

目的：探讨运用医疗失效模式与效应分析（HFMEA）降低住院结核病患者跌倒发生率的效果。方法：以2017年4月至2018年3月住院结核病患者为对照组,实施常规跌倒高危因素评估质控流程;以2018年4月至2019年3月住院结核病患者为观察组,实施基于HFMEA管理模式的跌倒评估质控流程,找出潜在失效模式,分析失效原因,提出改进措施并落实。比较应用HFMEA前后患者跌倒发生率。结果：应用HFMEA后,患者跌倒发生率较实施前明显下降,差异有统计学意义（P<0.05）。结论：将HFMEA 应用于住院结核病患者跌倒流程的管理,可准确把握跌倒风险预防的重点管理环节,有效降低跌倒发生率。     

医疗失效模式与效应分析在预防社区脑卒中跌倒中的应用

[目的]运用医疗失效模式与效应分析(HFMEA)方法对社区防跌倒管理流程进行改进并实施,以有效规避脑卒中患者跌倒高危因素,降低脑卒中患者跌倒发生率。[方法]选取2016年1-12月静安区某社区卫生服务中心管理的脑卒中患者163名。首先,进行脑卒中患者跌倒风险调查,了解跌倒发生情况,并进行多因素分析筛选跌倒高危因素;然后,采用HFMEA 方法,将上述调查对象随机分为二组,实施6个月干预,并对二组脑卒中患者首次入户随访时间、跌倒风险因素及跌倒次数进行评价。[结果]调查对象一年内跌倒发生率为31.29%,行走辅助用具、视力对日常的影响、对外界反应能力、脚无力是跌倒的独立危险因素,见表3。二组在首次入户干预时间、跌倒风险评估总分、跌倒次数方面存在显著差异 (P<0.05),见表4。[结论]运用医疗失效模式与效应分析(HFMEA)方法改进并实施社区防跌倒管理流程和控制方案,可降低跌倒风险,减少跌倒发生。     

平衡指数测定在老年住院患者跌倒风险评估中的应用

目的 探讨平衡指数测定在老年住院患者跌倒风险评估中的应用.方法 选择2012年3-10月收治于上海交通大学医学院附属第三人民医院内科的老年患者500例作为实验组,选择2011年内科系统实施院内监控的防跌倒患者500例作为对照组,实验组患者根据平衡指数值选择预防监控,对照组采用院内定性评分给予监控.分析两组患者住院期间跌倒发生情况、伤害发生情况和监控情况;分析实验组平衡指数与跌倒发生率的相关性.结果 平衡指数测定可降低老年患者住院期间跌倒发生率（P＜0.05）;实验组实施监控人数与对照组比较,差异有统计学意义（P＜0.05）.结论 平衡指数测定是一种科学的可量化的跌倒风险评估工具,为老年住院患者跌倒的预防提供科学依据,降低跌倒发生率,并能提高护士工作质量和效率.     

Effectiveness of an automatic manual wheelchair braking system in the prevention of falls

The purpose of this study was to evaluate the effectiveness of an automatic manual wheelchair braking system in the reduction of falls for patients at high risk of falls while transferring to and from a manual wheelchair. The study design was a normative survey carried out through the use of a written questionnaire sent to 60 skilled nursing facilities to collect data from the medical charts, which identified patients at high risk for falls who used an automatic wheelchair braking system. The facilities participating in the study identified a frequency of falls of high-risk patients while transferring to and from the wheelchair ranging from 2 to 10 per year, with a median fall rate per facility of 4 falls. One year after the installation of the automatic wheelchair braking system, participating facilities demonstrated a reduction of zero to three falls during transfers by high-risk patients, with a median fall rate of zero falls. This represents a statistically significant reduction of 78% in the fall rate of high-risk patients while transferring to and from the wheelchair, t (18) = 6.39, p < .0001. Incident reports of falls to and from manual wheelchairs were reviewed retrospectively for a 1-year period. This study suggests that high-risk fallers transferring to or from manual wheelchairs sustained significantly fewer falls when the Steddy Mate automatic braking system for manual wheelchairs was installed. The application of the automatic braking system allows clients, families/caregivers, and facility personnel an increased safety factor for the reduction of falls from the wheelchair.     

Effectiveness of an Automatic Manual Wheelchair Braking System in the Prevention of Falls

The purpose of this study was to evaluate the effectiveness of an automatic manual wheelchair braking system in the reduction of falls for patients at high risk of falls while transferring to and from a manual wheelchair. The study design was a normative survey carried out through the use of a written questionnaire sent to 60 skilled nursing facilities to collect data from the medical charts, which identified patients at high risk for falls who used an automatic wheelchair braking system. The facilities participating in the study identified a frequency of falls of high-risk patients while transferring to and from the wheelchair ranging from 2 to 10 per year, with a median fall rate per facility of 4 falls. One year after the installation of the automatic wheelchair braking system, participating facilities demonstrated a reduction of zero to three falls during transfers by high-risk patients, with a median fall rate of zero falls. This represents a statistically significant reduction of 78% in the fall rate of high-risk patients while transferring to and from the wheelchair, t(18) = 6.39, p < .0001. Incident reports of falls to and from manual wheelchairs were reviewed retrospectively for a 1-year period. This study suggests that high-risk fallers transferring to or from manual wheelchairs sustained significantly fewer falls when the Steddy Mate automatic braking system for manual wheelchairs was installed. The application of the automatic braking system allows clients, families/caregivers, and facility personnel an increased safety factor for the reduction of falls from the wheelchair.     

护理风险管理预防住院跌倒高危患者跌倒的实践及成效

目的探讨护理风险管理预防住院跌倒高危患者跌倒的实践及效果。方法 2010年1～12月对4230例跌倒高危患者采用常规预防跌倒管理方法,2011年1～12月对4900例跌倒高危患者采用预防跌倒风险管理。比较实施预防跌倒风险管理前后患者跌倒及跌倒损伤发生率,护士跌倒评估能力、防跌倒知识及跌倒处理能力达标率情况。结果实施护理风险管理后,跌倒高危患者跌倒及跌倒损伤发生率较实施前明显下降,护士跌倒评估能力、防跌倒知识及跌倒处理能力达标率较实施前明显提高。结论 防跌倒护理风险管理能有效预防患者跌倒,提升护理人员预防跌倒知识及能力,从而提高护理质量管理。     

Morse跌倒评估量表在脑卒中患者康复护理中的应用效果

目的探讨Morse跌倒评估量表在脑卒中患者康复护理中的应用效果。方法便利抽样法选择2012年6-12月在岳阳中西医结合医院治疗的74例脑卒中患者为研究对象,分别采用Morse跌倒评估量表和常规跌倒评估量表对其进行跌倒风险评估,比较两种评估量表的筛查结果。结果 Morse量表的AUC值为0.815,而常规量表为0.726,可知Morse量表略优于常规量表。采用Morse跌倒评估量表筛查跌倒高风险患者54例,占72.97%;使用常规量表筛查出跌倒高风险患者32例,占43.24%,差异有统计学意义(P0.05)。常规跌倒评估量表跌倒史漏检率为48.57%。两种量表评估的高危患者的年龄构成比的差异有统计学意义(P0.05)。结论应用Morse跌倒评估量表有助于临床识别跌倒高风险患者,具有较好的临床应用前景。     

Effect of a multidisciplinary fall risk assessment on falls among neurology inpatients

OBJECTIVE: To evaluate whether the addition of a physician assessment of patient fall risk at admission would reduce inpatient falls on a tertiary hospital neurology inpatient unit.PATIENTS AND METHODS: A physician fall risk assessment was added to the existing risk assessment process (clinical nurse evaluation and Hendrich II Fall Risk Model score with specific fall prevention measures for patients at risk). An order to select either “Patient is” or “Patient is not at high risk of falls by physician assessment” was added to the physician electronic admission order set. Nurses and physicians were instructed to reach consensus when assessments differed. Full implementation occurred in second-quarter 2008. Preimplementation (January 1, 2006, to March 31, 2008) and postimplementation (April 1, 2008, to December 31, 2009) rates of falls were compared on the neurology inpatient unit and on 6 other medical units that did not receive intervention.RESULTS: The rate of falls during the 7 quarters after full implementation was significantly lower than that during the 9 preceding quarters (4.12 vs 5.69 falls per 1000 patient-days; P=.04), whereas the rate of falls on other medical units did not significantly change (2.99 vs 3.33 falls per 1000 patient-days; P=.24, Poisson test). The consensus risk assessment at admission correctly identified patients at risk for falls (14/325 at-risk patients fell vs 0/147 low-risk patients; P=.01, χ2 test), but the Hendrich II Fall Risk Model score, nurse, and physician assessments individually did not.CONCLUSION: A multidisciplinary approach to fall risk assessment is feasible, correctly identifies patients at risk, and was associated with a reduction in inpatient falls.Falls are the most common adverse event reported in acute care settings.^1,2 They prolong hospitalization, increase cost of care, and have the potential to cause serious injury.³ Multiple risk factors for falls have been identified: advanced age, muscle weakness, gait or balance problems, visual impairment, altered bowel or bladder elimination patterns, dizziness or vertigo, depression, cognitive deficits, impaired activities of daily living, use of psychotropic medications, and a history of falls.^1,4-7 These risk factors are common among patients with neurologic disease. For this reason, several specific neurologic conditions, such as stroke, dementia, Parkinson disease, and peripheral neuropathy, confer an increased risk for falls,⁸ and neurology inpatient units have among the highest rates of falls.⁹Among hospitalized patients, rates of falls range from 1.97 to 8.40 falls per 1000 patient-days.^9-13 The rate of falls on our neurology inpatient unit was 5.69 falls per 1000 patient-days during 2006 and 2007. The objective of this study was to evaluate whether the addition of a physician fall risk assessment to the existing nurse fall risk assessment process was feasible and whether it would lead to a reduction in our inpatient rate of falls. Our hypothesis was that adding a physician assessment would increase the number of neurology inpatients identified as at risk for falls, leading to more patients receiving fall prevention measures and, ultimately, a reduction in rate of falls.     

中枢神经系统药物对老年患者跌倒的影响及护理措施

目的了解中枢神经系统药物对老年患者发生跌倒的影响,并提出针对性的护理措施。方法2007年3月-2009年3月在我科入住的老年患者中,因服用中枢神经系统药物后发生跌倒的患者38例,分析患者服用中枢神经系统药物后跌倒的发生率与性别、教育程度、健康状况、泌尿问题、视力问题及认知功能障碍的关系,以及服药时间与药物剂量与跌倒之间关系。结果男性跌倒发生率达78．95％,明显高于女性（21．05％）;年龄在76～85岁之间跌倒发生率最高,达52．63％;伴发心血管疾病和代谢疾病发生跌倒率明显高于其他类疾病;有基础性疾病者跌倒率明显增高。高剂量组和服药后0．5～1h跌倒发生率明显增高,与低剂量和其他时间段比较差异有统计学意义,P〈0．05。结论服用中枢神经系统药物对老年人跌倒的发生有严重影响;护理人员应特别重视老年患者中使用高剂量药物以及服药后1h内的观察,日常应加强用药宣教和陪护者跌倒防范意识的指导,减少老年患者跌倒事件的发生,有助于患者的康复。     

Implementation of a patient fall prevention program.

Falls among hospitalized patients are common occurrences and can have detrimental effects on patient outcomes. Identifying high-risk patients and taking measures to prevent patient falls have been successful. The purpose of this project was to decrease the fall rate in adult neuroscience patients. This was accomplished through implementation of a patient fall prevention program. Patients were assessed for risk factors associated with patient falls. Risk factors were identified through the use of the patient's history, nursing data base and patient classification system. Patients with identified risk factors were placed on fall precautions which included interventions specifically designed to prevent patient falls. This project resulted in a decrease in the number of patient falls and increased staff awareness of the risk factors associated with falls among adult neuroscience patients.