嘉義縣某地區醫院護理之家及精神病房慢性住院病人跌倒傷害嚴重程度相關因素研究

Identify and analyze the characteristics of patients who fall and the severity of injuries at the nursing home and psychiatric ward chronic hospitalized patients in a district hospital in Chiayi County

本研究之目的是針對嘉義縣某地區醫院護理之家及精神病房慢性住院病人跌倒事件做分析，探討護理之家及精神病房慢性住院病人跌倒之特性及影響病人跌倒傷害嚴重程度之相關因素。研究方法採回溯性調查方式，樣本取自跌倒時意外事件報告單，共搜集122名住院病人發生跌倒事件，收集期間從民國94年1月1日至97年12月31日，以SPSS統計套裝軟體進行統計分析。研究結果顯示：（1）本研究中住院跌倒的病人以15歲至未滿65歲者、男性、住護理之家者、有活動障礙者居多。另外，發生地點與時間以床邊及白天班時段為主，而跌倒時以正在上下病床，無親友陪伴或使用輪椅的狀況為最多。（2）研究對象跌倒發生率為0.048%，跌倒傷害率為47.54%，在跌倒傷害嚴重程度方面，無需醫療處置者佔七成八（無傷害佔52.5%，一級傷害佔25.4%），而需醫療處置者佔二成二（二級傷害佔18.0%，三級傷害佔4.1%）。（3）研究對象的年齡、住院別、藥物因素三者與跌倒傷害嚴重程度有顯著相關，其中65歲以上者、在護理之家者、無藥物因素者跌倒後較需醫療處置。（4）研究對象跌倒傷害嚴重程度的主要預測變項為「跌倒時活動狀態」及「性別」，且以「跌倒時活動狀態」最具有解釋力，其中研究對象是在走動時或女性者，跌倒時越傾向需醫療處置。跌倒傷害相關因素的確認可提供資訊於減低護理之家及精神病房慢性住院病人發生跌倒時的傷害並且發展出跌倒介入課程，尤其是當病患在走動時、女性與年齡為65歲以上者。而合宜正確的預防策略能夠確保病人安全、提昇醫療照護品質並且減少醫療資源的耗用。

The purpose of this study was to identify and analyze the characteristics of patients who fall and the severity of injuries at the nursing home and psychiatric ward chronic hospitalized patients in a district hospital in Chiayi County. Risk factors of falls and factors that altered the severity of injuries were analyzed. In this retrospective study, data were collected by reviewing fall records in the safety reporting system. There were 122 patients who fell occurring from January1, 2005 to December 31,2008 at the nursing home and psychiatric ward . Analysis were performed by use of SPSS statistical software. The analysis showed that (1) a higher incidence was found in the aged 15 to 65; the majority was male, nursing home residents and poor mobility; at the time of fall, most of them occurred at bedsides, during daytime, at getting out of bed ; at the time of fall, most of them were unaccompanied and wheelchair used; (2) the incidence rate for hospitalized patient falls was 0.048%, 47.54% had injuries after falling, and regarding the severity of injuries after falling which “no need medical handling” was 78% ( no injuries was 52.5% and first degree injuries was 25.4%) and “need medical handling” was 22% ( second degree injuries was 18.0% and third degree injuries was 4.1%); (3) To explore factors related to falls and the severity of injuries, it was found that age, unit and medication factors showed significant difference. It was found that over 65 years old, nursing home residents and no medication factors showed need more medical handling; (4) To explore the key influencing factors for fall-related injuries was “activity status of fall” and “sex”. It was found that walking status and female showed need more medical handling. The identified factors associated with injury may provide the information on reducing falling injuries for the nursing home and psychiatric ward chronic hospitalized patients, and development of fall intervention programs especially when patients were walking status, female and over 65 years old . The preventive strategies can ensure patient safety, improve health care quality and reduce resource utilization.