住院患者防跌倒专科化管理的方法及效果

目的实施住院患者防跌倒专科化管理,降低住院患者跌倒发生率。方法根据专科化管理的需要,修订防跌倒工作管理方案并建立防跌倒联络小组,由老年病专科护士对全院的护理管理人员、防跌倒联络小组和临床护士进行住院患者防跌倒知识培训,建立各专科的防跌倒指引。将防跌倒管理工作纳入夜查房督导内容,老年病专科护士负责日常检查督促,指导科室实施专科化防跌倒措施,对医院发生的跌倒病例进行资料回访,定期进行总结分析,并提出整改意见。结果 2008年全院患者跌倒发生率较2007年有明显下降(P0.01);护理人员对跌倒危机评分准确率和防跌倒护理措施落实率明显提高(P0.01)。结论专科化管理模式能发挥老年病专科护士业务特长,有效降低患者跌倒发生率。     

Prevention of falls among older patients in the hospital environment

Falls among older inpatients are a significant cause for concern, yet currently there is no national guidance on falls prevention programmes, and little evidence from the research literature on the effectiveness of hospital prevention programmes. This article explores the unique problems associated with falls in hospital, particularly the issues related to observation and supervision of patients with cognitive impairment. The evidence base for falls risk assessment and prevention strategies is examined. An interprofessional, multidimensional approach to falls and injury prevention is suggested as the most likely approach to be effective in hospital, and the contribution of specific strategies such as exercise and hip protection are examined. Ethical issues are considered and the role of restraint in falls management is rejected. The Kings College Hospital inpatient falls prevention programme is described as a practice example of an interprofessional, multidimensional approach. Finally, the nurse's role in implementing falls prevention strategies and leading future practice development is identified.     

对中高危跌倒患者应用护理专案管理的效果观察

目的 探讨对中高危跌倒患者实施护理专案管理的应用效果.方法 成立护理专案小组,采用方便抽样法选取2020年5月—2021年5月厦门市某三级专科医院心内科80名中高危跌倒患者为研究对象,将2020年5月1—15日40例中高危跌倒患者作为对照组,实施常规预防跌倒知识宣教.将2021年5月1—15日40例中高危跌倒患者作为观...     

Establishing a new falls clinic – conflicting attitudes and inter-sectoral competition affecting the outcome

Falls clinics are a newer model for falls management among the elderly. Few studies have addressed the impact of the strategy on falls prevention in the healthcare system. The aim of the present study was to describe the social processes that affect the implementation of new strategies in falls management. A newly established falls clinic was chosen as an instrumental case to describe the systematic and comprehensive approach to falls prevention among the elderly. The investigation had a qualitative case study research design with triangulation of sources and methods, including interviews, participant observation and analysis of documents. The study was conducted from January 2006 to June 2007 at a newly established falls clinic at a Danish hospital. Data were analysed qualitatively according to four main themes: The concept of falls, success/failure, competition and expertise. The study showed that the falls clinic was embedded in a context where interests varied at different levels of the organizational hierarchy. In contrast to the political agenda for falls prevention, patients and professionals did not associate falls with chronological age. The biomedical structure of the falls clinic and the hegemonic mode of handling falls prevention may have facilitated falls prevention services and patient trajectories across sectors, but if falls are associated with chronic disease secondary to an unhealthy lifestyle, the individual patient becomes responsible for the falls problem. This may subsequently prevent the patients from seeking timely help from the healthcare system, or patients may drop out of the existing programmes. Future research needs to look at sustainability and dropping out in relation to falls prevention programmes.     

防范及应对患者跌倒的方法与效果

目的 探讨防范及应对患者跌倒的方法.方法 对护士进行防范患者跌倒专项培训,提高安全意识及管理能力.对患者进行全面评估、醒目标识、切实履行告知义务、严格落实防跌倒护理措施、加强质量控制等多层面管理.结果 护士相关知识技能掌握程度提高,患者跌倒发生率下降,差异具有统计学意义(P＜0.01或P＜0.05).结论 采用对护士进...     

集束化管理策略联合分级预防措施预防贫血患者跌倒的效果观察

目的 探讨集束化管理策略联合分级预防措施预防血液内科贫血患者跌倒的效果。方法 选取2016年1~12月住院的贫血患者作为观察组,选取2015年1~12月住院的贫血患者作为对照组。对照组按照常规进行风险评估及预防跌倒的健康教育,落实预防跌倒的护理措施。观察组在对照组的基础上实施集束化管理策略联合分级预防。比较2组患者跌倒率、高风险跌倒上报率。结果 患者跌倒率由0.265次/(1 000患者·d)降至0.029次/(1 000患者·d),跌倒高风险上报率由0.716次/(1 000患者·d)升至2.488次/(1 000患者·d)。结论 集束化管理策略联合分级预防能实现血液内科贫血患者预防跌倒的高效管理,能有效筛选出贫血患者中的跌倒高风险人群,降低其跌倒率,保障患者的安全。     

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。     

安全文化建设在住院老年患者跌倒中的应用

目的 探索安全文化建设在住院老年患者跌倒管理中的应用与效果.方法 将安全文化建设的报告文化、公平文化、弹性文化和学习文化4方面内容,有效地应用到住院老年患者预防跌倒的护理管理中.结果 跌倒高危预报率增加,跌倒发生率降低,差异均具有统计学意义(P＜0.01或P＜0.05).结论 安全文化建设应用于住院老年患者跌倒的护理管...     

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。     

Fall prevention in hospitals: an integrative review

This article summarizes research and draws overall conclusions from the body of literature on fall prevention interventions to provide nurse administrators with a basis for developing evidence-based fall prevention programs in the hospital setting. Data are obtained from published studies. Thirteen articles are retrieved that focused on fall interventions in the hospital setting. An analysis is performed based on levels of evidence using an integrative review process. Multifactoral fall prevention intervention programs that included fall-risk assessments, door/bed/patient fall-risk alerts, environmental and equipment modifications, staff and patient safety education, medication management targeted to specific types, and additional assistance with transfer and toileting demonstrate reduction in both falls and fall injuries in hospitalized patients. Hospitals need to reduce falls by using multifactoral fall prevention programs using evidence-based interventions to reduce falls and injuries.     

“5E”预防策略在住院老年患者跌倒风险管理中的应用

目的运用"5E"预防策略对住院老年患者进行跌倒风险管理,为降低老年住院患者跌倒发生率提供依据。方法以老年内科患者268例为研究对象,对照组136例患者实施常规护理,干预组132例患者进行评估、教育预防、环境改善、工程学、强化执行"5E"预防策略干预。结果干预组住院老年患者跌倒发生率低于对照组,跌倒认知率高于对照组(P0.01)。结论 "5E"预防策略有利于提高老年患者跌倒认知率,降低跌倒发生率,提高老年住院患者的安全性。     

Where are falls prevention resources allocated by hospitals and what do they cost? A cross sectional survey using semi-structured interviews of key informants at six Australian health services

BackgroundFalls are a major problem for patients and hospitals, resulting in death, disability and increased costs of healthcare.ObjectivesThis study aimed to estimate the resource allocation across a partnership of large health services, in an attempt to understand the amount and variability of resource allocation to various falls prevention activities.DesignA cross sectional survey using semi-structured interviews.SettingSix tertiary health services in Australia.ParticipantsA collaboration of six health services, spanning twenty-eight hospitals, was formed to investigate falls prevention resource allocation. We interviewed 186 health service staff who were involved in falls prevention activities, such as projects, audits and risk management, clinical and operational managers responsible for falls prevention resource allocation and clinical staff on targeted acute, subacute and mental health wards.MethodsThis study used a mixed methods, cross sectional, observational design. To collect data, we used key informant interviews with a purposive and snowball sampled group of people working in the included health services. During interviews, study participants were asked where and how falls prevention resources and equipment were utilised and to estimate the time allocated to performing falls prevention activities. The opportunity cost of each activity was estimated. All costs were reported in Australian dollars.ResultsWe estimate the annual opportunity cost of health service attempts to prevent in-hospital falls across the six health services to be AU$46,478,014. If we extrapolate this to a national level, health services would be consuming AU$590 million per year in resources trying to prevent falls in hospital. The areas of greatest resource consumption were physiotherapy (18%), continuous patient observers (14%), falls assessments (12%) and screens (8%), and falls prevention alarms (11%). Falls prevention alarms and falls risk assessment screening tools were also used only for falls prevention, and are potentially ineffective falls prevention strategies.ConclusionsHealth services are investing considerable amounts of resource in attempting to prevent falls. However much of this resource is consumed in activities with weak or little evidence of effectiveness. Health services may be better served by considering tighter targeting, reduction or disinvestment in this area. This may release time and resources which could be used to provide interventions with a stronger evidence base, such as patient education using a structured patient education program or in other areas of practice where evidence of benefit exist.     

Assessing falls risk in older adult mental health patients: A Western Australian review

Falls are a common and costly complication of hospitalization, particularly in older adult populations. This paper presents the results of a review of 139 falls at two older adult mental health services in Western Australia, Australia, over a 12‐month period. Data were collected from the hospital incident report management system and from case file reviews of patients who sustained a fall during hospitalization. The results demonstrated that the use of different risk assessment and falls management tools led to variations in practice, policies, and management strategies. The review identified mental health‐specific falls risk factors that place older people with a mental illness at risk when admitted to the acute mental health setting. With the expansion of community mental health care, many older people with a mental illness are now cared for in a variety of health‐care settings. In assessing falls risk and implementing falls‐prevention strategies, it is important for clinicians to recognize this group as an ambulant population with a fluctuating course of illness. They have related risks that require specialized falls assessment and management.     

临床护理路径在预防老年住院患者跌倒中的应用效果

目的：探讨临床护理路径在预防住院老年患者跌倒管理中的实施效果。方法将676例≥65岁跌倒高危患者按随机数字表法分为对照组和观察组,每组338例。对照组采取常规护理模式（护理宣教、床头挂防摔倒警示标识、打起床栏等）;观察组采取临床护理路径管理模式,运用临床护理路径管理对患者进行护理干预,预防住院期间意外跌倒的发生。结果对照组发生跌倒5例,跌倒发生率为1.48%。观察组发生跌倒1例,跌倒发生率为0.29%,对照组跌倒发生率明显高于观察组（P＜0.05）。结论运用临床护理路径管理进行护理干预,能有效地预防住院老年患者意外跌倒的发生,降低老年住院患者跌倒的发生率。     

120例住院患儿跌倒原因分析及对策探讨

目的分析住院患儿跌倒发生的原因和特点,探讨减少住院患儿发生跌倒的对策。方法回顾120例住院患儿跌倒事件,分析患儿跌倒的特点及原因。结果 120例跌倒患儿中,男孩多于女孩,以0~4岁为主,主要发生在每日1601~2000;跌倒后52.50%的患儿发生不同程度伤害。跌倒的主要原因有患儿、家长、设备、环境以及其他因素。结论住院患儿跌倒与患儿自身特点以及有效的安全行为管理紧密相关,建议在住院患儿预防跌倒的安全管理中重视4岁以下、男孩及重点时段的跌倒管理,提高家长的安全意识,建立防跌倒的医院安全文化等。     

典型情境安全行为模拟演练模式在老年住院患者跌倒预防中的应用分析

目的 观察典型情境安全行为模拟演练模式在老年住院患者跌倒预防中的应用效果。方法 选择2019年1-12月收治于笔者所在医院的跌倒高风险老年住院者200例为研究对象,将收治于奇数病室的100例老年患者设为对照组,收治于偶数病室的100例老年患者设为试验组,对照组按常规模式施行跌倒预防管理,试验组在对照组基础上加用典型情境安全行为模拟演练干预,比较2组预防安全行为知识掌握度评分、安全行为执行度评分及跌倒事件发生率。结果 试验组跌倒预防安全行为知识掌握度评分与安全行为执行度评分均显著高于对照组(t=28.385,P<0.001;t=21.591,P<0.001),住院期及出院后3个月内跌倒事件发生率均显著低于对照组(χ²=5.128,P=0.024;χ²=4.688,P=0.030)。结论 采用典型情境安全行为模拟演练模式对老年住院患者开展跌倒预防管理,可显著提升老年住院患者跌倒预防安全行为知识掌握度与安全行为执行度,降低住院期及出院后跌倒事件发生风险。     

Evidence-based management practice: reducing falls in hospital

This paper reports on a falls prevention and management program at one regional Western Australian hospital. The report focuses on the processes and outcomes of a quality management initiative to reduce falls in hospital to illustrate the nexus between research and quality improvement in clinical practice. The Falls Prevention program was based on statistical evidence of the level of risk in the hospital and development of an evidence-based multidimensional, multidisciplinary program to reduce the risks of falling and the number of falling events. Evaluative data demonstrate the effectiveness of the program in terms of a substantial reduction in falls. The program illustrates the value of evidence-based practice, particularly in relation to evidence-based management practice. It supports the merits of creating an organisational climate where all clinicians are encouraged to use research data to plan strategies for quality improvement and risk management and, in the process, advance clinical nursing knowledge development.     

预见性护理在预防老年住院患者跌倒中的应用

目的探讨预防老年住院患者跌倒发生的有效护理管理方法。方法对2009--2010年收治的65岁以上住院患者实施预见性护理干预,与实施常规护理患者（2008年）进行对比,比较跌倒发生率情况及对护理工作的满意率。结果老年住院患者跌倒发生率2009年与2008年同比下降了0．93‰,2010年与2008年同比下降了0．8‰;对护理工作的满意度2009年比2008年提高了3．9％,2010年比2008年提高了3．8％;实施预见性护理后老年住院患者跌倒发生率及对护理工作的满意度与实施前比较,差异均有统计学意义（P〈0．05）。结论实施有效的预见性护理干预,在预防老年住院患者跌倒中具有重要作用。     

Nursing students’ experience with fall risk assessment in older adults

The purpose of this study was to examine the perceptions of nursing students regarding barriers and facilitators to integrating falls risk evaluation and management into practice as well as effective strategies for learning falls prevention. The qualitative research method of thematic analysis was adopted to collect data through semi‐structured interviews with senior nursing students. Open and axial coding was used to analyze the data and those with greatest support generated final categories. Thematic analysis identified five central themes (learning to do a fall risk assessment, addressing health beliefs of older adults, barriers to fall assessment, and overcoming barriers) that describe nursing student perceptions of incorporating fall prevention into practice. Results of this study indicate that an online program enhanced with opportunity for hands‐on practice provides an effective strategy for learning fall prevention that can be incorporated into nursing practice. Further research is needed to understand how to overcome barriers to integrating fall prevention into practice.