病房内便携式护理站是否能降低住院患者跌倒率？一项中断时间序列分析。

Do portable nursing stations within bays of hospital wards reduce the rate of inpatient falls? An interrupted time-series analysis.

机构信息

Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Centre for Statistics in Medicine, University of Oxford, Oxford, UK.

Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Centre for Rehabilitation Research in Oxford, University of Oxford, Oxford, UK.

出版信息

Age Ageing. 2018 Nov 1;47(6):818-824. doi: 10.1093/ageing/afy097.

DOI:10.1093/ageing/afy097

PMID:30010697

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6201822/

Abstract

BACKGROUND

falls can negatively affect patients, resulting in loss of independence and functional decline and have substantial healthcare costs. Hospitals are a high-risk falls environment and regularly introduce, but seldom evaluate, policies to reduce inpatient falls. This study evaluated whether introducing portable nursing stations in ward bays to maximise nurse-patient contact time reduced inpatient falls.

METHODS

inpatient falls data from local hospital incident reporting software (Datix) were collected monthly (April 2014-December 2017) from 17 wards in Stoke Mandeville and Wycombe General Hospitals, the UK. Portable nursing stations were introduced in bays on these wards from April 2016. We used a natural experimental study design and interrupted time series analysis to evaluate changes in fall rates, measured by the monthly rate of falls per 1000 occupied bed days (OBDs).

RESULTS

the wards reported 2875 falls (April 2014-December 2017). The fallers' mean age was 78 (SD = 13) and 58% (1624/2817) were men. Most falls, 99.41% (2858/2875), resulted in none, low or moderate harm, 0.45% (13/2875) in severe harm and 0.14% (4/2875) in death. The monthly falls rate increased by 0.119 per 1000 OBDs (95% CI: 0.045, 0.194; P = 0.002) before April 2016, then decreased by 0.222 per 1000 OBDs (95% CI: -0.350, -0.093; P = 0.001) until December 2017. At 12 months post-intervention, the absolute difference between the estimated post-intervention trend and pre-intervention projected estimate was 2.84 falls per 1000 OBDs, a relative reduction of 26.71%.

CONCLUSION

portable nursing stations were associated with lower monthly falls rates and could reduce inpatient falls across the NHS.

摘要

背景

跌倒会对患者造成负面影响，导致其丧失独立性和功能下降，并产生大量医疗保健费用。医院是高风险跌倒环境，经常引入但很少评估降低住院患者跌倒风险的政策。本研究评估了在病房中引入便携式护理站以最大限度地增加护士与患者的接触时间是否能降低住院患者跌倒率。

方法

从英国斯托克曼德维尔和怀科姆综合医院的 17 个病房的本地医院事件报告软件（Datix）中每月收集住院患者跌倒数据（2014 年 4 月至 2017 年 12 月）。2016 年 4 月，在这些病房的病房中引入了便携式护理站。我们使用自然实验研究设计和中断时间序列分析来评估跌倒率的变化，用每月每 1000 个占用床日（OBD）的跌倒率（每 1000 个 OBD 的跌倒率）来衡量。

结果

病房报告了 2875 例跌倒（2014 年 4 月至 2017 年 12 月）。跌倒者的平均年龄为 78 岁（SD=13 岁），58%（1624/2817）为男性。大多数跌倒（99.41%，2858/2875）造成无、低或中度伤害，0.45%（13/2875）造成严重伤害，0.14%（4/2875）造成死亡。2016 年 4 月前，每月跌倒率每 1000 OBD 增加 0.119（95%CI：0.045，0.194；P=0.002），然后在 2017 年 12 月前每月跌倒率每 1000 OBD 减少 0.222（95%CI：-0.350，-0.093；P=0.001）。干预后 12 个月，干预后估计趋势与干预前预测估计之间的绝对差异为每 1000 OBD 2.84 例跌倒，相对减少 26.71%。