Centre for the Humanities and Health Sciences, Department of Nursing Science, Charité Universitätsmedizin Berlin, Berlin, Germany.
J Eval Clin Pract. 2010 Jun;16(3):464-9. doi: 10.1111/j.1365-2753.2009.01143.x. Epub 2010 Mar 11.
Falls and fall-related injuries are major problems in hospitals. The aim of this study was to examine the impact of fall prevention guidelines on falls and fall-related injuries in hospitals.
A cross-sectional study was conducted in German hospitals. Some 28 hospitals participated with a total of 5046 patients. Eleven of these hospitals had already implemented a fall prevention guideline, 10 were in the process of developing such a guideline and seven hospitals were not using any fall prevention guideline at all. A standardized questionnaire was used on the individual patient level to obtain details regarding the socio-demographic background, falls, fall-related injuries and other problems relevant to nursing. A further questionnaire referred to the use of fall prevention guidelines in the individual hospitals. Data specific to falls were analysed both on hospital level and on ward and patient level by means of a multilevel logistic model.
The univariate analyses suggest that patients in hospitals that are using guidelines are more likely to fall [odds ratios (OR) = 1.19, confidential interval (CI) = 0.65-2.18] than in hospitals that do not use any guideline (reference category) or are still in the developing stage (OR = 0.82, KI = 0.77-0.87). If, in a multivariate analysis, the ward level and individual patient variables (age, disorientation, confusion, incontinence) are included, the following results are obtained: the probability of falls in hospitals not using guidelines (reference category) is higher than in hospitals developing a guideline (OR = 0.86, KI = 0.58-1.28) or using a guideline (OR = 0.71, KI = 0.44-1.14). The differences are even more distinct regarding the injuries resulting from a fall that require medical treatment. The probability of these injuries is significantly lower in hospitals using guidelines (OR = 0.27, KI = 0.09-0.85) than in hospitals developing a guideline (OR = 0.61, KI = 0.24-1.54) or not using any guidelines at all (reference category).
The present results of the multilevel analysis show that falls and fall-related injuries can be reduced by the implementation of fall prevention guidelines.
跌倒和与跌倒相关的伤害是医院的主要问题。本研究的目的是检验预防跌倒指南对医院跌倒和与跌倒相关伤害的影响。
在德国医院进行了一项横断面研究。共有 28 家医院参与，共有 5046 名患者。其中 11 家医院已经实施了预防跌倒指南，10 家医院正在制定这样的指南，7 家医院根本没有使用任何预防跌倒的指南。在个体患者层面上使用标准化问卷获取关于社会人口统计学背景、跌倒、与跌倒相关的伤害以及与护理相关的其他问题的详细信息。另一份问卷涉及个体医院对预防跌倒指南的使用情况。通过多水平逻辑模型，分别在医院和病房及患者层面上分析与跌倒相关的数据。
单变量分析表明，使用指南的医院的患者跌倒的可能性更高[比值比（OR）=1.19，置信区间（CI）=0.65-2.18]，而不使用任何指南的医院（参考类别）或仍处于发展阶段的医院（OR=0.82，CI=0.77-0.87）。如果在多变量分析中纳入病房层面和个体患者变量（年龄、定向障碍、意识混乱、尿失禁），则得到以下结果：不使用指南的医院（参考类别）的跌倒发生率高于制定指南的医院（OR=0.86，CI=0.58-1.28）或使用指南的医院（OR=0.71，CI=0.44-1.14）。因跌倒而需要治疗的伤害结果的差异更为明显。使用指南的医院发生这些伤害的概率显著降低（OR=0.27，CI=0.09-0.85），而制定指南的医院（OR=0.61，CI=0.24-1.54）或根本不使用任何指南的医院（参考类别）则较高。
多水平分析的结果表明，通过实施预防跌倒指南，可以减少跌倒和与跌倒相关的伤害。
