跌倒危險因子

Risk Factor of Fall

病患跌倒指標是台灣醫療品質指標計畫之一。跌倒指標可讓醫療機構監 測其病患跌倒的發生趨勢及評估跌倒對病患所發生的影響，更可進一步探討 如何預防，而防範病患跌倒的有效策略，首先必須能正確評估病患有跌倒傾 向的危險特徵'故本研究的目的為：一、確立影響住院病患跌倒的生理因 素；二、評估住院病患跌倒與藥物治療的關條；三、確立影響住院病患跌倒 的環境因素。採回溯性個案控制（Case-control） 的方法。以參加台灣醫療品質 指標計畫之醫學中心及區域醫院，各取三家為研究對象。於民國90 年6 月1 日 至8 月31 日住院期間內，發生有正式紀錄之跌倒病患，俟跌倒組病患出院後， 非跌倒組依控制變項（年齡士10 歲、性別、診斷、跌倒事件發生前住院天 數、疾病嚴重度）進行回溯性個案配對，共202 對（合計404 名病患）。研究工 具包括跌倒組及控制組之基本資料問卷表、意識狀態評估表（Glasgow Coma Scale） 及疾病嚴重度量表（Charlson Comorbidity Score） 。資料來源、為病患跌倒 紀錄表及病歷紀錄。研究結果：一、跌倒生理因素：（一）入院時有失眠（二）跌倒前一天下肢無力（三）跌倒前一天血壓不穩（四）最近一年跌倒超 過一次以上，與跌倒有顯著的相關；二、跌倒與藥物因素：跌倒前24 小時內 服用鎮靜安眠劑，與跌倒有顯著的相關；三、跌倒與環境的相關性：無家屬 陪伴者與跌倒有顯著的相關。研究結果可提供護理人員正確評估高危險病患 及採取防範措施，以確保病患安全。

Patient falls is one of Taiwan Quality Indicator Project (TQIP). It not only provides the trends of patient falls, but also assesses the effect of patients from fall. To assess the risk factors of fall is the first step of fall prevention strategy. The purposes of this study were as following: (1) to identify physical risk factor of falls in hospitalized patients; (2) to evaluate the risk for falls associated with exposures to drugs; (3) to identify environmental risk factor of fall in hospitalized patient. This retrospective case-control study was performed in each three medical center and community hospital. 202 cases were reported as having fallen after being admitted between June 1, 2001 and August 31, 2001. The 202 controls were matched by age (within 10 year), gender, diagnosis, pre-event length of stay and patient acuity. The study tools included incidence report, Glasgow Coma Scale and Charlson Comorbidity Score. The results of the study were: (1) physical factor: the leg weakness, insomnia at admission, unstable blood pressure, history of falls (the previous 1 year) were correlated with a fall; (2) exposure to drugs: the use of sedative/hypnotic agents within the previous 24 hours; (3) Environmental factor: no family company were correlated with a fall. Risk factors were identified which will benefit nurses in assessing the patients to prevent falls.