Titler Marita G, Shever Leah L, Kanak Mary F, Picone Debra M, Qin Rui
University of Michigan School of Nursing, Ann Arbor, MI 48109-5482, USA.
Res Theory Nurs Pract. 2011;25(2):127-48. doi: 10.1891/1541-6577.25.2.127.
Falls of hospitalized older adults are of concern for patients, family members, third-party payers, and caregivers. Falls are the most common safety incident among hospitalized patients with fall rates from 2.9-13 per 1,000 patient days. Little effectiveness research has been conducted on nursing interventions and other variables associated with falls of older adults during hospitalization.
The purpose of this exploratory outcomes effectiveness study was to examine variables associated with falls during hospitalization of older adults.
An effectiveness research model composed of patient characteristics, clinical conditions, nursing unit characteristics, medical, pharmacy, and nursing interventions was tested using generalized estimating equations (GEE) analysis. The sample consisted of 10,187 hospitalizations of 7,851 patients, aged 60 or older, admitted for acute care services over a 4-year period. Those included in the sample either had received the Nursing Interventions Classification (NIC) intervention of Fall Prevention (defined as "instituting special precautions with patient at risk for injury from falling" [Dochterman & Bulechek, 2004, p. 363]) or were at risk for falling as defined by a fall risk assessment scale. Data were obtained retrospectively from 9 clinical and administrative data repositories from 1 tertiary care hospital.
Variables that were positively associated with falls, after controlling for other variables in the model, included several medical and nursing treatments; several types of medications including antidepressants, benzodiazepines, antipsychotic, and psychotropic agents; and several types of nursing treatments including restraints and neurologic monitoring (at low use rates of < 2 times a day). Variables inversely associated with falls included registered nurse (RN) skill mix, pressure ulcer care, pain management, and tube care.
The study demonstrates the importance of conducting interdisciplinary effectiveness research that includes nursing care. Most of the variables associated with falls were interventions (medical, pharmacy, and nursing). Dose of nursing treatments and RN skill mix were also associated with falls.
住院老年人跌倒问题受到患者、家属、第三方支付方及护理人员的关注。跌倒是住院患者中最常见的安全事件，跌倒发生率为每1000个患者日2.9 - 13次。关于住院期间老年患者跌倒相关的护理干预及其他变量的有效性研究较少。
本探索性结局有效性研究旨在探讨与老年患者住院期间跌倒相关的变量。
使用广义估计方程（GEE）分析对由患者特征、临床状况、护理单元特征、医疗、药学及护理干预组成的有效性研究模型进行检验。样本包括7851名60岁及以上患者在4年期间因急性护理服务而住院的10187次病例。样本中的患者要么接受了预防跌倒的护理干预分类（NIC）干预（定义为“对有跌倒受伤风险的患者采取特殊预防措施”[多奇特曼和布勒切克，2004年，第363页]），要么根据跌倒风险评估量表被判定有跌倒风险。数据是从一家三级护理医院的9个临床和行政数据库中回顾性获取的。
在控制模型中的其他变量后，与跌倒呈正相关的变量包括几种医疗和护理治疗；几种类型的药物，包括抗抑郁药、苯二氮䓬类药物、抗精神病药和精神药物；以及几种类型的护理治疗，包括约束和神经监测（每天使用次数<2次的低使用率情况）。与跌倒呈负相关的变量包括注册护士（RN）技能组合、压疮护理、疼痛管理和管道护理。
该研究表明开展包括护理在内的跨学科有效性研究的重要性。与跌倒相关的大多数变量是干预措施（医疗、药学和护理方面的）。护理治疗剂量和RN技能组合也与跌倒有关。
