跌倒评分表在老年住院病人中的应用

目的：减少老年住院病人发生跌倒几率及不必要的医疗纠纷。方法：应用跌倒评分表对新入院老年病人进行评估,6分以上的高危人群予加强防范措施,责任护士及时与病人或其家属进行安全防范沟通并签字。结果：实施1年多来,发生1例病人跌倒,未出现医疗纠纷。结论：跌倒评分表内容简洁,使用方便,只要认真评估并采取有效措施,可减少病人跌倒的发生及医疗纠纷,值得推广。     

跌倒危险度评分表在中老年住院病人中的应用

[目的]探讨跌倒危险度评分表在老年住院病人中的应用。[方法]将356例65岁以上有跌倒史的老年住院病人随机分为对照组和观察组,对照组采用固定方式进行健康教育,观察组使用跌倒危险度评分表对病人进行评估,之后根据评估结果进行个体化健康教育,评价跌倒的发生率及健康教育知识认知情况。[结果]观察组住院期间再次跌倒比例明显低于对照组（P〈O．01）,且教育后健康教育认知水平明显提高。[结论]依据跌倒危险度评估情况进行个体化授课的健康教育方式对预防老年人跌倒有显著效果。     

17例老年住院患者跌倒危险因素分析及对策

目的探讨老年住院患者跌倒的危险因素,并总结防范措施。方法对17例老年住院患者发生跌倒事件的危险因素进行回顾性分析。结果本组17例患者跌倒的诱因分别为排便9例（52．9％）,环境中存在不安全因素4例（23．5％）,心理因素2例（11．8％）,吐痰1例（5．9％）,呕吐1例（5．9％）;病床旁跌倒8例（47．1％）,如厕时跌倒6例（35.3％）,座椅边跌倒2例（11．8％）,外出检查跌倒1例（5．9％）;夜间跌倒者11例（64．7％）;7例跌倒者无陪护在场（41．2％）;4例（23．5％）老年患者跌倒后未造成明显伤害,其余13例（767．5％）患者均造成了不同程度的伤害。结论控制跌倒危险因素和加强防范意识教育是降低老年住院患者跌倒发生率的根本措施。     

住院老年精神病患者22例跌倒原因分析及护理

目的探讨住院老年精神病患者跌倒原因,为制定相应护理干预措施提供依据。方法对162例老年精神病住院患者中发生过跌倒患者的临床资料进行回顾性分析,针对跌倒原因制定相应护理干预措施。结果住院老年精神病患者跌倒发生率为14．0％（22例）,其中阿尔茨海默病患者跌倒多见（40．9％）．跌倒原因内在因素占50．0％,其次为药物不良反应（36．3％）。结论对老年精神病患者在住院期间进行综合护理干预,可以减少跌倒事件的发生。     

跌倒危险度评分表在老年病房的应用研究

目的对老年住院患者跌倒危险性进行评估,根据评估结果制定个性化的防跌倒方案,指导护士对有跌倒危险老年患者的护理,有效预防住院老年患者跌倒的发生。方法将332例老年患者随机分为实验组166例和对照组166例,其中实验组用跌倒危险度评分表进行评估,并采取相应预防措施,对照组按常规护理。结果332例病例中,实验组老年人跌倒发生1例,对照组老年人跌倒发生6例。结论跌倒危险度评分表已在国外研究中取得良好效果,也可以为我国在跌倒的评估和预防中提供参考和借鉴。     

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。     

“1＋3”质量管理模式防范住院患者跌倒的实施与体会

住院患者发生跌倒是常见的护理不良事件。有报道指出,156例被调查的住院患者1年中有90例曾发生过跌倒,占57．69％;而90例跌倒的老年患者共发生171次跌倒。跌倒已成为美国社会老年人死亡的第6位原因。防范住院患者跌倒是医院护理质量管理中的一个重要方面,也是评价医院医疗护理质量的一个重要指标。     

综合干预预防住院老年精神病患者跌倒的观察

目的探讨针对性综合干预治疗对老年精神病住院患者跌倒事件及发生率的影响。方法采用对环境、患者、护理人员三方面综合干预的方法．对512例老年精神病住院患者与往年同期495例老年住院患者进行比较。结果干预组发生跌倒事件45人次（8．79％）．对照组73人次（14．7％）,（x^2=8．64,P〈0．01）,并且跌倒导致的损伤情况也有极显著性差异（x^2=17．89．P〈0．01）。结论对精神病老年患者在住院期间进行综合干预．可以减少跌倒事件的发生。     

老年脑血管病患者跌倒的相关因素分析

目的研究老年脑血管病患者跌倒的相关因素,从而有效的预防跌倒的发生。方法对12个月内有跌倒史的老年脑血管病患者102例进行调查。结果男性患者跌倒发生率为42．16％,女性患者为6．86％;独居患者跌倒发生率为37．25％,同住患者为16．67％;平衡能力正常的患者跌倒发生率为22．55％,异常患者为38．24％,差异均有统计学意义（χ2分别为4．95,8．45,5．13;P〈0．05或P〈0．01）;不同年龄、是否服药、不同夜尿情况、视力、智力及伴有不同慢性病患者跌倒发生率比较差异均有统计学意义（P〈0．05或P〈0．01）。结论老年脑血管病患者跌倒是多种因素共同作用的结果,护理重在预防,正确评估老年脑血管病患者的身体状况,制定有效的预防措施,从而减少跌倒的发生。     

住院病人跌倒的原因分析及防范措施

[目的]探讨防范住院病人跌倒现象发生的应对措施。[方法]对住院期间发生跌倒的15例病人进行分析。[结果]经过护理干预及预防,大大降低了住院病人的跌倒率。[结论]对病人防止跌倒的护理,重在预防,加强病房管理、重视健康教育、科学评估,能够有效防止病人跌倒的发生,减少因为病人跌倒而造成的医疗纠纷,确保护理安全,提高病人及家属满意度。     

中国医院病人负性事件的调查研究

目的调查中国医院病人负性事件的现状及其特点。方法调查中国内地的9 698名护士,对护士报告的4种病人负性事件发生情况进行分析。结果报告给药错误、院内压疮、病人跌伤和身体约束"曾经发生"的护士分别为47.39%、57.64%、34.47%和68.84%。东北部医院护士报告的给药错误、病人跌伤和身体约束概率低于其他区域医院;直辖市比省会或其他城市医院护士报告较多的病人跌伤;内科护士报告较多的给药错误和病人跌伤,ICU护士报告较多的院内压疮和身体约束。结论中国医院病人负性事件发生率高,提示管理者需加强对病人负性事件的关注,采取针对性措施,为病人提供安全的就医环境。     

The coming of age of a joint elderly medicine-psychiatric ward: 18 years' experience

INTRODUCTION: There is a large population of elderly medical inpatients with co-existent medical and mental health disorders who pose a significant management challenge for medical, nursing and allied staff. Our hospital has a joint elderly medicine-psychiatry unit to cater for this patient group; this article reviews how this unit was set up and presents a representative sample of inpatients. RESULTS: The mean age was 81 years with a female preponderance. The mean length of stay was 44 days. The commonest medical conditions were cerebrovascular disease, urinary tract infections, chest infections and falls. The commonest mental health diagnoses were cognitive impairment, delirium and depression. The mortality rate was 21%; of the remainder, 55% were discharged to long-term care, 40% returned home and 5% were transferred to the local psychiatric hospital. DISCUSSION: This cohort of elderly patients has complex medical, nursing and therapy needs in addition to complex discharge planning needs. Our unit has a shared care approach, with joint responsibility shared by a consultant in Medicine for the Elderly and a Consultant in Old Age Psychiatry. This, in combination with a multidisciplinary team approach, provides an effective means of delivering care to this patient group. CONCLUSION: A joint elderly medicine-old age psychiatry ward provides a high standard of care for elderly patients with co-existent physical and mental health needs. We hope that the information presented in this article will be of use to those hoping to set up a similar unit in their own hospitals.     

2014－2018年江苏省苏州市乙型肝炎病例就诊流向和就诊医院等级分布情况

目的了解江苏省苏州市乙型肝炎（乙肝）病例就诊流向和就诊医院级别，为苏州市乙肝防治过程中医疗资源的合理配置提供决策依据。方法在国家法定传染病报告信息系统导出2014 — 2018年现住址在苏州市的乙肝确诊病例，应用Excel 2013软件进行数据整理和分析，利用R软件（3.6.1版）的circlize程序包绘制苏州市乙肝病例就诊流向，用R软件中的networkD3程序包绘制病例就诊流向和就诊医院等级的桑基图，用ArcGIS 10.3软件绘制病例的外地就诊地图。结果苏州市乙肝病例跨市就诊比例为9.74%，市内各区/县的乙肝病例就诊流向主要为本区/县内就诊（64.24%）；跨区域就诊主要为苏州市区病例集中流向姑苏区，下设的外围4个县级市病例流向上海市；跨区域就诊病例赴三级甲等医院比例为73.48%（3 370/4 586），高于本区/县内病例赴三甲医院就诊比例15.67%（1 291/8 237），OR＝14.91（95% CI: 13.65～16.29）。结论苏州市乙肝患者就诊以本区/县内医疗机构为主，跨区域就诊主要流向姑苏区和上海市两地的三级医疗机构。     

Missed nursing care, staffing, and patient falls

Patient falls in hospitals continue to be a major and costly problem. This study tested the mediating effect of missed nursing care on the relationship of staffing levels (hours per patient day [HPPD]) and patient falls. The sample was 124 patient units in 11 hospitals. The HPPD was negatively associated with patient falls (r = -0.36, P < .01), and missed nursing care was found to mediate the relationship between HPPD and patient falls.     

Evaluation of the Morse Fall Scale: applicability in Chinese hospital populations

BACKGROUND: Patient falls have been identified as a significant health problem in the general hospital patient population. The Morse Fall Scale (MFS) is an individualized criterion-referenced assessment tool designed for measuring the likelihood of patient falls in hospitals. Despite the scale has demonstrated high validity and reliability in the previous researches, this study is to provide additional validity tests to determine the applicability in the Chinese hospital population. OBJECTIVES: To examine the predictive power of the MFS to predict patient falls. To conduct reliability tests on internal consistency, item analysis, inter-rater and test-retest reliability. DESIGN: The study was a cross-sectional study. SETTINGS: The medical and geriatric units of three rehabilitation hospitals in Hong Kong participated in the study. PARTICIPANTS: A convenience sample of 954 Chinese patients was recruited sequentially upon admission in the hospital ward units. They ranged in age from 17 to 100 years, with a mean of 70.2 years. METHODS: The patients were assessed for fall risk using the MFS on admission. Data was collected on the number of patients who fell rather than the number of falls. RESULTS: The scale had a sensitivity of 31% and a specificity of 83% when the cut-off point was determined at 45. The field test demonstrated excellent inter-rater reliability with an ICC value of 0.97 (95%CI 0.94-0.98). Repeatability was high with an ICC of 0.98 (95% CI 0.98-0.99). The evaluation revealed a low Cronbach's alpha coefficient and a low to moderate item-to-scale correlation. CONCLUSIONS: The evidence collected in this study has shown both the positive and negative aspects of using the MFS in assessing the fall risk of Chinese patients during rehabilitation. The discriminative validity and internal consistency reliability provide researchers and clinicians with a major step in further developing or modifying the scale.     

Exploring falls prevention capabilities,barriers and training needs among patient sitters in a hospital setting: A pilot survey

Older patients in hospitals are at high risk of falls. Patient sitters are sometimes employed to directly observe patients to reduce their risk of falling although there is scant evidence that this reduces falls. The primary aim of this pilot survey (n = 31) was to explore the patient sitters' falls prevention capability, self-efficacy and the barriers and enablers they perceived influenced their ability to care for patients during their shifts. Feedback was also sought regarding training needs. Most (90%) participants felt confident in their role. The most frequent reasons for falls identified were patient-related (n = 91, 64%), but the most frequent responses identifying preventive strategies were environment-related (n = 54, 64%), suggesting that the sitters' capability was limited. The main barriers identified to keeping patients safe from falling were patient-related (n = 36, 62%) such as cognitive impairment. However, opportunities that would enable sitters to do their work properly were most frequently categorized as being staff-related (n = 20, 83%), suggesting that the sitters have limited ability to address these barriers encountered. While 74% of sitters reported they had received previous training, 84% of participants would like further training. Patient sitters need more training, and work practice needs to be standardized prior to future research into sitter use for falls prevention.     

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。     

Fall incidence and fall prevention practices at acute care hospitals in Singapore: a retrospective audit

OBJECTIVE: To investigate the incidence of falls and explore fall prevention practices at acute care hospitals in Singapore. DESIGN: A retrospective audit to collect baseline data on (1) incidence of falls (patient fall rates and fall injury rates) and (2) fall prevention practices, was conducted in five acute care hospitals in Singapore from December 2004 to March 2005. STUDY PARTICIPANTS: Medical record data (n = 6000) of patients admitted into the medical, surgical and geriatric units in the five hospitals. OUTCOME MEASURES: Fall incidence was obtained from the hospital's fall databases and incident reports for the period of June 2003 to May 2004. In total, 6000 medical records from five hospitals were randomly selected, retrieved and reviewed to determine whether falls, fall assessments and interventions were being initiated and documented. RESULTS: The number of fallers for all hospitals was 825. Analysis showed that patient fall rates ranged from 0.68 to 1.44 per 1000 patient days, and the proportion of falls associated with injury ranged from 27.4% to 71.7%. The use of a fall risk assessment tool by nurses was recorded in 77% of all the nursing records. CONCLUSION: This study has laid the foundation for further research for fall prevention in Singapore by describing current fall rates, fall-associated injury rates and the status of fall prevention practices in acute care settings. The results will be used to inform the development of a tailored multifaceted strategy to facilitate the implementation of Fall Prevention Clinical Practice Guidelines to reduce the burden of falls and fall injuries in hospitals in Singapore.     

照顾者与住院老年患者跌倒相关性的研究

目的分析照顾者与老年患者跌倒发生率的相关性,为制定护理预防措施及相关宣教内容提供科学依据。方法抽取北京市10个城区的10所医院274名老年人进行问卷调查。结果老年患者在有人照顾的情况下跌倒发生率为31.97%,①亲属照顾跌倒率为67.98%,高于非亲属照顾跌倒率43.75%。②有照顾经历者跌倒率为65.33%,高于无照顾经历者跌倒率50.81%。③经专业培训或非专业培训者跌倒率低于未培训凭经验者跌倒率。结论照顾者的身份、经历、照顾知识来源与住院老年患者跌倒发生率具有相关性,应加强对照顾者护理专业知识的培训和管理,强化其安全意识,最大程度降低住院老年患者跌倒发生率。     

Patient falls: profile for prevention

Patient falls are common in the hospital or long-term care setting. In a large Southwestern teaching hospital, patient falls have been monitored on an ongoing basis. A multidisciplinary task force developed a method of identifying patient fall risk factors. A survey was used concurrently as falls were reported during the month of July. Forty-seven falls were reported. Of this sample, neurological patients accounted for 12 (25.5%) of the incidents. The neurological patient fall profile was identified as a high-risk profile, and interventions were taken to prevent falls in this group. A second data collection was conducted six months later with this population. While the number of patients on the neurological services remained constant, the incidence of falls decreased (25%). By using a comprehensive approach of data collection and assessment, education, and follow-up, the institution has decreased neurological patient falls.