運用神通廣大策略降低神經科病房病人跌倒發生率

Using the ''Shen、Tong、Guang、Da'' Strategy to Reduce Incidental Falls in the Neurological Wards

神經科病人常見步態不穩、視力模糊、頭暈、意識障礙等症狀，容易增加跌倒風險；調查2016年1月至6月期間，跌倒發生率高達0.108％，原因為病人不遵從、照顧者對防跌認知差、訊息傳遞不足、防跌設備不足。專案以「神、通、廣、大」口號策略進行改善措施，「神」：指制定神經科防跌照護須知及遵從登錄表、提醒卡、海報與團衛；「通」：指增設離床通報機；「廣」：指廣泛評估防跌能力與巡修環境設備如製作床欄保護墊、床上及輪椅安全帶；「大」：則是指團隊大家共同參與防跌措施。專案執行後跌倒發生率由0.108％降至0.023％達專案目的，跌倒傷害率31.9％降至27.3％，強化防跌觀念、落實防跌措施及提升病人安全。

Patients with neurological disease usually manifest with gait instability, blurred vision, dizziness, disturbance of consciousness, and other symptoms, thus increasing the risk of incidental falls. A survey from January to June 2016 showed that the incidence of falls was as high as 0.108%. Risk factors include poor patient compliance, among shift caregivers, inadequate handover of fall prevention information inadequate fall prevention awareness, the lack of fall prevention equipment. The present project uses the strategy slogan of ''Shen, Tong, Guang, Da''. The Shen (Neurological) means to develop the neurological fall prevention instructions, registration form, reminder card, posters, and group health education service. The Tong (Report) means to apply a bed-exit alarm system in the ward. Guang (Comprehensive) means to provide comprehensive evaluation of fall prevention ability and frequently check the environment and equipment, such as bed rails, protection mats, and wheelchair seat belts. Da (Team) means to team up everyone to participate in fall prevention. Through these strategies, the incidence of incidental falls decreased from 0.108% to 0.023% and the injury rate fell from 31.9% to 27.3%. Also, the concept of falling prevention was strengthened, fall prevention measures were implemented and patient safety was improved.