Department of Nursing & Patient Care Services, University of Iowa Hospitals & Clinics, Iowa City, IA 52242-1009, USA.
Worldviews Evid Based Nurs. 2012 Feb;9(1):18-29. doi: 10.1111/j.1741-6787.2011.00227.x. Epub 2011 Sep 19.
Patient falls remain a common adverse event in acute care facilities. Findings from research into structured nursing rounds interventions (SNRIs) indicate promise as a fall prevention practice. Translating, adapting, and sustaining SNRI in real world clinical practices is an important next step.
The purpose of this study was to evaluate the feasibility of adapting and translating a SNRI to reduce the risk and incidence of patient falls on two orthopedic inpatient units. It was hypothesized that SNRI would reduce fall rates up to 1-year postintervention and that patient risk factors and documented SNRI activities would predict falls.
Using a repeated measures design, fall rates and risk assessment data were collected at baseline, during the 12-week SNRI implementation, and 1-year following implementation. The adapted SNRI included hourly prescribed rounding activities documented on a study specific form. Medical records of patient falls were reviewed for each period. Focus groups were conducted with nurses' postintervention.
Observed (probability) fall rates were 1.8%, 0.8%, and 1.1% for the three periods, respectively. Numbers of falls per 1,000 hospital days (incidence) were 4.5, 1.6, and 3.2 for the three periods. Mean fall risk assessment scores were 2.7 ± 1.1, 2.7 ± 1.1, and 2.5 ± 1.1 for the three periods. Fall rates declined during SNRI (borderline trend), yet 1-year follow-up rates drifted back toward baseline. SNRI dosage and fall risk scores did not predict fall rates. Patients who fell during the three periods were not at greatest risk. Nurses interpreted SNRI as an imposition and the documentation a burden.
Findings illuminate the multiple challenges in translational research. SNRI appeared to reduce fall rates initially, but fidelity to the SNRI implementation and documentation was variable and fall reduction gains appeared lost 1 year later. Nurses expressed the importance of balancing intervention fidelity and individualizing patient interventions.
患者跌倒仍是急性护理机构常见的不良事件。有关结构化护理查房干预（SNRI）的研究结果表明，这是一种有希望的预防跌倒的实践方法。将 SNRI 转化、适应并持续应用于真实临床实践是下一步的重要工作。
本研究旨在评估改编和翻译 SNRI 以降低 2 个骨科住院病房患者跌倒风险和发生率的可行性。研究假设 SNRI 可将跌倒率降低 1 年，患者风险因素和记录的 SNRI 活动可预测跌倒。
使用重复测量设计，在基线、12 周 SNRI 实施期间和实施后 1 年收集跌倒率和风险评估数据。改编后的 SNRI 包括在特定研究表格上记录的每小时规定查房活动。对每个时间段的患者跌倒医疗记录进行了审查。干预后对护士进行了焦点小组讨论。
观察（概率）跌倒率分别为三个时间段的 1.8%、0.8%和 1.1%。每 1000 个住院日的跌倒数（发生率）分别为三个时间段的 4.5、1.6 和 3.2。三个时间段的平均跌倒风险评估得分分别为 2.7 ± 1.1、2.7 ± 1.1 和 2.5 ± 1.1。SNRI 期间跌倒率下降（边缘趋势），但 1 年随访率又回到基线。SNRI 剂量和跌倒风险评分均不能预测跌倒率。在三个时间段内跌倒的患者并非风险最大。护士将 SNRI 解释为一种强加的要求，而记录则是一种负担。
研究结果阐明了转化研究中的多个挑战。SNRI 似乎最初降低了跌倒率，但对 SNRI 实施和记录的一致性存在差异，1 年后跌倒减少的效果似乎丧失了。护士强调了平衡干预一致性和个体化患者干预的重要性。
