Nelson Audrey, Powell-Cope Gail, Gavin-Dreschnack Deborah, Quigley Pat, Bulat Tatjana, Baptiste Andrea S, Applegarth Shawn, Friedman Yvonne
James A. Haley VAMC, 11605 N. Nebraska Avenue (118M), Tampa, FL 33612-5738, USA.
Nurs Clin North Am. 2004 Sep;39(3):649-71. doi: 10.1016/j.cnur.2004.05.001.
New technologies designed to help prevent adverse events related to the mobility of geriatric patients (ie, patient falls, bed-rail entrapment, patient handling, and wandering) are described. Technology offers the potential to eliminate or mitigate preventable adverse events that interfere with treatment, delay rehabilitation, potentiate impairment, and compromise patient safety. Unchecked, these adverse events can have a negative impact on patient health, functional status, and quality of life. It is not surprising that the elderly constitute the population at highest risk for adverse events, based on poor health, chronic conditions, long hospitalizations, and institutional care. Patient falls are a high-risk, high-volume, and high-cost adverse event. Key technologies to prevent falls and fall-related injuries include hip protectors, wheelchair/scooter safety features, intelligent walkers, fall alarms, and environmental aids. Bed-rail entrapment is a serious adverse event, which includes patients being trapped, entangled, or strangled in beds. New technologies to prevent bed-rail entrapment include new hospital bed designs, height-adjustable low beds, devices to close gaps in legacy beds, and bedside floor mats. Patients with mobility impairments necessitate physical assistance in transfers and other patient-handling tasks, which increases risk for the caregiver and the patient. Featured technologies to prevent patient handling injuries include innovations in floor-based lifts, new ceiling-mounted patient lifts, and improvements in powered standing lifts, new friction-reducing devices, and new patient transport technology. Wandering affects 39% of cognitively impaired nursing home residents and up to 70% of community-residing elderly persons with cognitive impairments. New technologies to prevent adverse events associated with wandering include door alarms and signal-transmitting devices. Nurses in geriatric settings would benefit from exposure to technologies that could improve patient and caregiver safety. To maximize the benefits of technology, it is critical that front-line nursing staff be involved in the testing and selection of devices that will be used in their practice. Further, to reap the full benefits of technology, a careful plan for implementation needs to be developed that would include integrating the new technology with existing infrastructure. Training needs to be provided for all staff who will be using the technology, and efforts to ensure competency over time is needed. A major barrier to widespread use of new technology is cost. Further research is needed to demonstrate the cost effectiveness of these devices. Results from these studies will help to build a business case, demonstrating that initial capital investments will result in cost savings, improved quality of care, and other benefits.
本文介绍了旨在预防与老年患者移动性相关的不良事件(如患者跌倒、床栏卡住、患者搬运和走失)的新技术。技术有可能消除或减轻那些干扰治疗、延迟康复、加剧损伤并危及患者安全的可预防不良事件。如果不加以控制,这些不良事件会对患者健康、功能状态和生活质量产生负面影响。鉴于老年人健康状况不佳、患有慢性病、住院时间长以及接受机构护理,他们成为发生不良事件风险最高的人群也就不足为奇了。患者跌倒是一种高风险、高发生率且高成本的不良事件。预防跌倒及跌倒相关伤害的关键技术包括髋部保护器、轮椅/踏板车安全装置、智能助行器、跌倒报警器和环境辅助设备。床栏卡住是一种严重的不良事件,包括患者被困、缠住或勒死在床上。预防床栏卡住的新技术包括新型医院病床设计、高度可调节的低床、用于封闭老式病床间隙的装置以及床边地板垫。行动不便的患者在转移和其他患者搬运任务中需要身体协助,这增加了护理人员和患者的风险。预防患者搬运伤害的特色技术包括地面升降机的创新、新型天花板式患者升降机、电动站立式升降机的改进、新型减摩装置以及新型患者运输技术。走失影响39%的认知障碍养老院居民以及高达70%的社区认知障碍老年人。预防与走失相关不良事件的新技术包括门报警器和信号传输装置。老年护理环境中的护士将受益于接触那些可提高患者和护理人员安全的技术。为了使技术的益处最大化,一线护理人员参与将在其实践中使用的设备的测试和选择至关重要。此外,为了充分利用技术,需要制定一个详细的实施计划,其中包括将新技术与现有基础设施整合。需要为所有将使用该技术的人员提供培训,并需要努力确保随着时间推移他们具备相应能力。新技术广泛应用的一个主要障碍是成本。需要进一步研究以证明这些设备的成本效益。这些研究的结果将有助于建立一个商业案例,表明初始资本投资将带来成本节约、改善护理质量及其他益处。