改善復健病人跌倒發生率之成效

Effectiveness of Fall Prevention amongst Patients during Rehabilitation

目的：本院復健中心病人跌倒發生率由2010年之0.129‰提升至2011年之0.186‰，跌倒事件發生的增加造成病人於復健治療時的危險性。據此，秉持以病人為中心之目標，設立目標值為0‰，確保復健治療之品質。方法：成立跨團隊專案小組，由流程檢視及特性要因分析，找出病人跌倒的原因。依實際發生跌倒之原因、文獻…等，同時融入病人、家屬及照顧者之建議，擬定對策為：1.設計安全腰帶；2.建立跌倒高危險群篩檢表；3.運用ISBAR建置病人交接表；4.以無障礙空間為概念，重新規劃治療空間；5.運用簡易鮮豔之圖形製作圖卡型衛教單張和海報；6.以神經、肌肉骨骼和感覺系統為基礎設計簡易之平衡運動訓練和利用本體感覺神經肌肉誘發概念設計元氣操，將之拍成宣導影片。結果：對策執行至2012年12月結果果顯示，跌倒發生率由0.186‰降至0.067‰，達成率為64％、進步率是64％。結論：策略之實施可減少造成病人跌倒的風險，降低跌倒發生率。針對內、外在跌倒因素的預防，治療師扮演相當重要的角色，是溝通之橋樑，如能加上病人、家屬和照顧者配合，可有效避免復健病人跌倒發生。

Purposes: All hospitalized patients are at risk for falls, especially during rehabilitation. With the increasing incidence between 2010 and 2011 (0.129‰ to 0.186 ‰), falls have received increased attention by our Hospital Rehabilitation Center. To provide a secure environment for rehabilitation and strengthen patient-centered care, reducing falls is compulsory. Therefore, the goal of the current study was set to decrease the rate of falls to 0 ‰ to ensure the quality of rehabilitation. Methods: A multi-disciplinary team was assembled to conduct the project and utilized several procedures to develop fall prevention strategies, including a literature review, cause determination (using the Cause-Effect Diagram), and family and caregivers’ experiences. The strategies administered involved the following: 1. design a belt; 2. establish a screening table for monitoring falls; 3. applying ISBAR to build a transfer table for patients; 4. re-designing the treatment room based on the concept of accessible movement; 5. producing leaflets and posters using easy and colorful graphics for promoting health education; 6. developing a simple balance exercise training program based on the concept of neuroanatomy; and 7. designing gymnastics routines by focusing on proprioceptive neuromuscular skills and formatting as a short film. Results: The incidence of falls decreased from 0.186 ‰ to 0.067 ‰ from 2011 to 2012. The accomplishment rate was 64% and the progression rate was 64%. Conclusions: The implementation of fall prevention strategies prevented patients from falling. For the multifactorial effects of fall prevention, not only do the clinicians play a very important role as communicators, but families and caregivers are needed to work closely to provide healthy and secure lives for patients undergoing rehabilitation.