運用多元化策略降低內科住院病人跌倒發生率

Applying Diversified Strategies to Reduce the Incidence of Falls in Hospitalized Medical Patients

跌倒為住院病人常見的不良事件，病人於住院期間發生跌倒可能導致受傷及住院天數延長，嚴重時甚至造成死亡。針對跌倒高危險病患採取積極主動的跌倒預防措施可減少住院病患的跌倒發生。本專案目的為降低住院病人跌倒發生率，針對北部某醫學中心於2016年內科住院病人的跌倒事件，該期間的跌倒事件共13件，其中屬重度跌倒有1件，發生率為0.08%，經分析發現病人跌倒主要原因包括：一、人員：護理師未提供預防跌倒衛教指導、不知道照顧者已更換；病人自覺可獨自下床活動、未使用呼叫鈴；病人需要協助但照顧者熟睡叫不醒、照顧者不知照護注意事項、忘記衛教內容；二、設備制度：床欄縫隙過大、無規則的檢核機制；三、衛教工具：衛教手冊文字多且字體小。為了解決這些問題，我們制定了多元化策略，包含運用海報、圖卡、多媒體影音短片、防跌乾坤挪移方案、防跌軟墊護欄、拉拉防跌帶及舉辦醫療人員教育訓練、制定查核機制。在預防跌倒專案介入後，住院病人跌倒發生率降至0.04%。

Patient falls are common adverse events in the hospital and lead to injury, longer lengths of stay and even death. Proactive fall prevention protocols for patients at high risk for falls reduce inpatient falls. This project aimed to reduce the fall incidence of patients within the hospital. In 2016, the number of fall events in a medical ward of a medical center in northern Taiwan was 13, including one severe case. The incidence of inpatient falls was 0.08%. The causes of inpatient falls included: 1. Personnel aspects: nurses did not provide nursing education for fall prevention, and did not recognize change of patient’s caregivers; patients thought that they could get out of bed on their own and did not ring the alarm bells when needing help; caregivers could not be awaken when needed by the care recipient; and caregivers were not aware of the care instructions and forgot the content of nursing education. 2. Equipment system: the space between of bedside rails was too large; no regular inspection was performed by hospital staff. 3. Educational tools: a font size was too small with too many words in the education texts. In order to solve the problems, we developed diversified strategies, which included posters, graphic cards, multimedia videos, fall prevention solutions, fall prevention padded railing, fall prevention belts, medical staff education and training, and the assessment mechanisms. After the intervention, the incidence of inpatient falls dropped to 0.04%.