Barker Anna L, Morello Renata T, Ayton Darshini R, Hill Keith D, Brand Caroline A, Livingston Patricia M, Botti Mari
Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
School of Physiotherapy and Exercise Science, Curtin University, Bentley, Western Australia, Australia.
PLoS One. 2017 Feb 15;12(2):e0172005. doi: 10.1371/journal.pone.0172005. eCollection 2017.
There is limited evidence to support the effectiveness of falls prevention interventions in the acute hospital setting. The 6-PACK falls prevention program includes a fall-risk tool; 'falls alert' signs; supervision of patients in the bathroom; ensuring patients' walking aids are within reach; toileting regimes; low-low beds; and bed/chair alarms. This study explored the acceptability of the 6-PACK program from the perspective of nurses and senior staff prior to its implementation in a randomised controlled trial. A mixed-methods approach was applied involving 24 acute wards from six Australian hospitals. Participants were nurses working on participating wards and senior hospital staff including: Nurse Unit Managers; senior physicians; Directors of Nursing; and senior personnel involved in quality and safety or falls prevention. Information on program acceptability (suitability, practicality and benefits) was obtained by surveys, focus groups and interviews. Survey data were analysed descriptively, and focus group and interview data thematically. The survey response rate was 60%. Twelve focus groups (n = 96 nurses) and 24 interviews with senior staff were conducted. Falls were identified as a priority patient safety issue and nurses as key players in falls prevention. The 6-PACK program was perceived to offer practical benefits compared to current practice. Nurses agreed fall-risk tools, low-low beds and alert signs were useful for preventing falls (>70%). Views were mixed regarding positioning patients' walking aid within reach. Practical issues raised included access to equipment; and risk of staff injury with low-low bed use. Bathroom supervision was seen to be beneficial, however not always practical. Views on the program appropriateness and benefits were consistent across nurses and senior staff. Staff perceived the 6-PACK program as suitable, practical and beneficial, and were open to adopting the program. Some practical concerns were raised highlighting issues to be addressed by the implementation plan.
在急性医院环境中，支持预防跌倒干预措施有效性的证据有限。“6-PACK预防跌倒计划”包括一个跌倒风险工具；“跌倒警报”标识；在浴室对患者进行监督；确保患者的助行器伸手可及；如厕制度；低低床；以及床/椅警报器。本研究在一项随机对照试验实施之前，从护士和高级职员的角度探讨了“6-PACK计划”的可接受性。采用了混合方法，涉及澳大利亚六家医院的24个急性病房。参与者是在参与病房工作的护士和医院高级职员，包括：护士单元经理；高级医师；护理主任；以及参与质量与安全或预防跌倒工作的高级人员。通过调查、焦点小组和访谈获取有关计划可接受性（适用性、实用性和益处）的信息。对调查数据进行描述性分析，对焦点小组和访谈数据进行主题分析。调查回复率为60%。进行了12个焦点小组（96名护士）和24次对高级职员的访谈。跌倒被确定为患者安全的首要问题，护士是预防跌倒的关键人员。与当前做法相比，“6-PACK计划”被认为具有实际益处。护士们一致认为跌倒风险工具、低低床和警报标识对预防跌倒很有用（超过70%）。对于将患者的助行器放置在伸手可及的位置，看法不一。提出的实际问题包括设备的获取；以及使用低低床导致工作人员受伤的风险。浴室监督被认为是有益的，但并不总是可行。护士和高级职员对该计划的适宜性和益处的看法一致。工作人员认为“6-PACK计划”是合适的、实用的且有益的，并愿意采用该计划。提出了一些实际问题，突出了实施计划需要解决的问题。
