Staggs Vincent S, Mion Lorraine C, Shorr Ronald I
Jt Comm J Qual Patient Saf. 2014 Aug;40(8):358-64. doi: 10.1016/s1553-7250(14)40047-3.
Many hospitals classify inpatient falls as assisted (if a staff member is present to ease the patient's descent or break the fall) or unassisted for quality measurement purposes. Unassisted falls are more likely to result in injury, but there is limited research quantifying this effect or linking the assisted/unassisted classification to processes of care. A study was conducted to link the assisted/unassisted fall classification to both processes and outcomes of care, thereby demonstrating its suitability for use in quality measurement. This was only the second known published study to quantify the increased risk of injury associated with falling unassisted (versus assisted), and the first to estimate the effects of falling unassisted (versus assisted) on the likelihood of specific levels of injury.
A cross-sectional analysis of falls from all available 2011 data for 6,539 adult medical, surgical, and medical-surgical units in 1,464 general hospitals participating in the National Database of Nursing Quality Indicators" (NDNQI) was performed.
Participating units reported 166,883 falls (3.44 falls per 1,000 patient-days). Excluding repeat falls, 85.5% of falls were unassisted. Assisted and unassisted falls were associated with different processes and outcomes: Fallers for whom a fall prevention protocol was not in place were more likely to fall unassisted than those for whom one was in place (adjusted odds ratio [aOR], 1.39 [95% confidence interval (CI), 1.32, 1.46]), and unassisted falls were more likely to result in injury (aOR, 1.59 [95% CI, 1.52, 1.67]).
The assisted/unassisted fall classification is associated with care processes and patient outcomes, making it suitable for quality measurement. Unassisted falls are more likely than assisted falls to result in injury and should be considered a target for future prevention efforts.
许多医院为了质量衡量目的，将住院患者跌倒分类为协助跌倒（如果有工作人员在场以减轻患者跌倒或防止跌倒）或非协助跌倒。非协助跌倒更有可能导致受伤，但量化这种影响或把协助/非协助分类与护理过程相联系的研究有限。开展了一项研究，将协助/非协助跌倒分类与护理过程及结果相联系，从而证明其适用于质量衡量。这是已知的第二项量化非协助跌倒（相对于协助跌倒）相关受伤风险增加的已发表研究，也是第一项估计非协助跌倒（相对于协助跌倒）对特定损伤程度可能性影响的研究。
对参与“国家护理质量指标数据库”（NDNQI）的1464家综合医院中6539个成人内科、外科及内科-外科科室2011年所有可用数据中的跌倒情况进行横断面分析。
参与的科室报告了166883次跌倒（每1000个患者日有3.44次跌倒）。排除重复跌倒后，85.5%的跌倒是非协助跌倒。协助跌倒和非协助跌倒与不同的过程及结果相关：未实施跌倒预防方案的跌倒患者比实施了方案的患者更有可能发生非协助跌倒（校正比值比[aOR]，1.39[95%置信区间(CI)，1.32，1.46]），且非协助跌倒更有可能导致受伤（aOR，1.59[95%CI，1.52，1.67]）。
协助/非协助跌倒分类与护理过程及患者结果相关，使其适用于质量衡量。非协助跌倒比协助跌倒更有可能导致受伤，应被视为未来预防工作的目标。
