降低某外科病房病人跌倒發生率之專案

A Project to Reduce Patient's Falls in A Surgical Ward

跌倒造成病人傷害，也增加醫療成本、照顧者負擔及影響醫療照護士氣。經分析醫院病安資訊系統資料，2017/01/01至2020/09/30期間病房跌倒發生率0.045%，傷害率65%，以中度為主。分析原因有八項：一、防跌衛教及評值完整性低；二、未給予衛教單；三、陪病者防跌認知不足；四、單向衛教，互動討論少；五、病人無病識感，自覺有能力下床；六、病人不願麻煩他人，獨自下床；七、病人怕影響病室氣味不願使用床邊便盆椅；八、陪病者離開或未全程陪同如廁。本專案透過實施教育課程及團體衛教、團隊合作參與防跌措施、設置防跌警示牌、警示器、QR code、病房專屬官方Line、提升防跌文化及關注力(病安公佈欄及事件分析手冊)、互動式衛教及定期稽核等。方案實施後，病房跌倒發生率自0.045%降低至0.021%，有效達到降低跌倒發生率之病安目標。

Fall prevention requires considerable medical attention. Falls cause injuries that increase health-care costs and caregiver burden, and they may affect the morale of nursing staff. This study analyzed data derived from a patient safety computer database for the period of January 1, 2017, to September 30, 2020. The incidence rate of falls in a surgical ward was 0.045%. Of the falls that occurred, 65% led to injuries, most of which were classified as moderate. Eight reasons for falls were identified. First, the nurses of the ward did not provide comprehensive guidance on fall prevention, and no evaluation system was implemented. Second, fall prevention leaflets were not distributed to the patients of the ward during education sessions. Third, the caregivers who were involved lacked awareness of fall prevention. Fourth, the fall prevention education that was implemented was one-sided, that is, not involving interaction between the patients and their families or caregivers. Fifth, some patients lacked awareness and were attempting to stand up hastily. Sixth, some patients did not want to cause inconvenience to others by seeking help. Seventh, some patient did not want to use a bedside commode. Finally, some patients were not accompanied by their family members or caregivers during their trips to the bathroom. Interventions for reducing fall rates were implemented. They included introducing educational courses for health-care staff, group health education for patients and their families, and teamwork focused on fall prevention. Furthermore, fall prevention warning signs and warning devices were installed; QR codes and an official LINE group for the ward were created; and a patient safety bulletin board, interactive health education, and regular auditing framework were introduced. After the implementation of the intervention program, the incidence rate of falls decreased from 0.045% to 0.021%, indicating the effectiveness of the patient safety intervention.