University Children's Medical Institute, Singapore.
Int J Evid Based Healthc. 2013 Mar;11(1):33-8. doi: 10.1111/1744-1609.12003.
This study aims to reduce the incidence of falls in paediatric inpatients aged 3 and below by implementing fall prevention strategies.
The Joanna Briggs Institute Practical Application of Clinical Evidence System and Getting Research into Practice programmes were used for this project. The project was carried out in three phases over a 4-month period from March to June 2011. A fall prevention poster was introduced during the implementation phase, and pre- and post-implementation audits were carried out in a 43-bed acute care paediatric ward in Singapore, with a sample size of 30.
The audit result of Criterion 1, evaluating the effectiveness of the fall prevention measures, improved by 13%, to 93%. Criterion 2, measuring nurses' compliance in the regular reinforcement of safety, improved significantly by 27%, to 40%. However, Criterion 3, which measured nurses' compliance in identifying patients at high risk of falls by placing a green identification wrist tag on such patients, decreased by 23%, to 50%.
A multi-language poster on fall prevention was strategically positioned at the foot of all the cots. The poster served as an effective reminder and communication method between nurses and caregivers and also among caregivers of the child. Caregivers' increased awareness and knowledge of fall prevention contributed to a 50% decrease in fall incidence of patients aged 3 and below in the presence of a caregiver from January to June 2011, as compared with the incidence rate in 2010.
This project has shown that fall incidents can be reduced when caregivers' awareness of fall prevention measures in the hospital setting were to be improved. The poster on fall prevention has increased caregivers' awareness and reduced inpatient falls in the acute care setting. The pre- and post-implementation audits showed that the presence of a poster on fall prevention to remind parents/caregivers to raise and securely lock the cot rails at all times was effective in reducing the number of falls for children aged 3 years and below. The experience gained from this project was that communication to every staff member and caregivers is essential in implementing practice change. As a result of the study, the hospital plans to implement constant monitoring and reminders to nurses and caregivers to improve compliance to the recommended measures on fall prevention in the near future.
通过实施预防跌倒策略，降低 3 岁及以下儿科住院患儿的跌倒发生率。
本项目使用了 Joanna Briggs 研究所循证实践应用与实施（PARIHS）框架和获取研究证据转化实践（G）两个工具。该项目于 2011 年 3 月至 6 月期间分 3 个阶段进行，历时 4 个月。在实施阶段引入了预防跌倒宣传海报，在新加坡一家拥有 43 张急性儿科病床的病房中进行了实施前后的审核，样本量为 30 例。
审核标准 1（评估预防跌倒措施的有效性）的结果提高了 13%，达到 93%；标准 2（衡量护士定期强化安全措施的依从性）显著提高了 27%，达到 40%；但是标准 3（通过为高跌倒风险患者佩戴绿色识别腕带识别患者）下降了 23%，至 50%。
多语言预防跌倒宣传海报被战略性地贴在所有婴儿床的床脚处。海报不仅是护士和照护者之间，也成为了照护者之间的有效提醒和沟通方式。照护者对预防跌倒措施的认识和知识的提高，使 2011 年 1 月至 6 月 3 岁及以下患儿的跌倒发生率与 2010 年相比降低了 50%。
本项目表明，当提高医院环境中照护者对预防跌倒措施的认识时，可以降低跌倒事件的发生。预防跌倒宣传海报提高了照护者的意识，减少了急性护理环境中的住院患者跌倒。实施前后的审核表明，在预防跌倒宣传海报上提醒家长/照护者始终抬高并安全锁定婴儿床护栏，对降低 3 岁以下儿童的跌倒发生率是有效的。从该项目中获得的经验是，与每位员工和照护者进行沟通对于实施实践变革至关重要。作为研究的结果，医院计划在不久的将来实施对护士和照护者的持续监测和提醒，以提高对预防跌倒推荐措施的依从性。
