某區域教學醫院住院病患跌倒事件分析

An analysis on accidental falls of hospitalized patients in a local teaching hospital

本研究旨在探討住院病患跌倒事件的發生率和傷害嚴重程度，並瞭解引起跌倒的危險因子及傷害嚴重程度的相關因素。採回溯性調查研究法，資料收集自中部某區域教學醫院2006年住院病患安全通報系統有紀錄的跌倒事件進行分析比較。計有112位住院病患跌倒，經分析結果為（1）基本屬性：以男性居多（64.3%），年齡以65歲以上老人最高（44.6%），教育程度以國小以下最多（64.3%）；（2）內在因素：以內科病患發生率最高（24.1%），跌倒時意識清醒狀態有85.7%，當時較虛弱無力佔36.6%，下床步態不穩者有46.4%，有服用降壓藥物佔53.6%；（3）外在因素：跌倒地點以在床邊最多（52.7%），跌倒當時多為無使用約束（97.3%），時間在白班多（42%），跌倒當時多為無人在旁陪伴（61.6%），且發生在入院第一週內多（66.1%）；（4）跌倒傷害嚴重程度：住院病患跌倒發生率（0.08%），而跌倒後傷害佔58.4%，跌倒後有傷害以住院三週以上，以一級傷害（78.0%）居多，嚴重程度以三級傷害較一級傷害為高，且有顯著差異（P<0.002）。導致跌倒原因錯綜複雜，本研究提出建議（1）加強預防跌倒相關知識；（2）針對高危險群病患，注意其生理變化及衛教宣導；（3）加強照顧者陪伴與照顧能力；（4）加強改善環境與藥物使用老年病患的安全教育。護理人員應以病患特質及疾病情況，持續監測跌倒因子並加強防範，以提昇以病患安全為中心之照護品質。

This study aimed to invesfigate the incidence of accidental falls in hospitalized patients and the severity of the injuries. Risk factors of falls and factors that altered the severity of the injuries were analyzed. Retrospective study was used to analyze and compare fall records in the safety reporting system for hospitalized patients. Data were collected from a local teaching hospital in central Taiwan in 2006. There were 112 hospitalized patients with falls, the analysis showed that (1) regarding the basic characteristics: the majority was male (64.3%), a higher incidence was found in the elderly aged 65 or above (44.6%), and most of them had elementary education level or lower (64.3%); (2) regarding the internal factors: the highest incidence was found in patients from the internal medicine department (24.1%), and at the time of fall, 85.7% of the patients were conscious, 36.6% were weak, 46.4% could not walk stably after getting out of bed, and 53.6% had taken antihypertensive medication; (3) regarding the external factors: most falls occurred at bedsides (52.7%), and at the time of fall most of them did not use restraints (97.3%), most of them occurred during daytime (42%), most of them were unaccompanied (61.6%), and most of them occurred in the first week of hospitalization (66.1%); (4) regarding the severity of injuries: the incidence for hospitalized patient falls was 0.08%, 58.4% had injuries after falling, and after falling, among injured patients that required 3-week or longer hospitalization, most of them were first degree injuries (78.0%), third degree injury was more severe than first degree injury with a significant difference (P<0.002). The cause of falls was complicated. The study suggestis (1) reinforce knowledge of fall prevention; (2) pay attention to physiological changes and health education of high-risk patients; (3) improve accompanying and care skills of caregivers; (4) reinforce elderly safety education on the aspects of environment and drug uses. Nurses should be aware of the characteristics and the conditions of illness in patients hospitalized, close monitoring factors of falls and preventing accidental falls to increase the quality of care based on the safety of patients.