J Emerg Nurs. 2020 Sep;46(5):666-674. doi: 10.1016/j.jen.2020.03.007. Epub 2020 Jun 4.
Patient falls in the emergency department are a unique patient safety issue because of the often challenging nature of the environment. As there are a variety of potential causative factors for patient falls in the emergency department, this project employed a multifactorial approach to prevent patient falls in a Level 1 trauma center emergency department (adult only) in an urban tertiary care teaching hospital.
This project was a single-unit quality improvement intervention that compared postintervention monthly unit-level data to historic monthly rates on the same unit. The intervention was multifaceted with patient-level, nurse-level, and unit-level interventions employed. A task force was convened to review and identify specific departmental gaps related to fall prevention, complete a retrospective review of departmental patient falls to determine causative factors, and implement interventions to reduce ED falls. A comprehensive program consisting of an ED-specific fall risk assessment tool, remote video monitoring (RVM), stretcher alarms, and a robust patient safety culture, among other interventions, was implemented. Patient falls and falls with injuries were tracked as an outcome measure.
After data driven analysis of causation, selection of key interventions, staff education, and sustained focus for 2 years, the department experienced a 27% decrease in falls and a 66% decrease in falls with injuries.
A multifactorial approach was an effective strategy to decrease patient falls in the emergency department.
由于急诊环境的挑战性，患者在急诊室跌倒属于独特的患者安全问题。由于急诊室患者跌倒有多种潜在的致病因素，因此该项目采用多因素方法来预防城市三级教学医院一级创伤中心急诊室（仅限成人）的患者跌倒。
该项目是一项单一单位的质量改进干预措施，将干预后的每月单位级别数据与同一单位的历史每月数据进行比较。干预措施是多方面的，包括患者层面、护士层面和单位层面的干预措施。成立了一个工作组来审查和确定与预防跌倒相关的特定部门差距，对部门患者跌倒进行回顾性审查以确定致病因素，并实施减少 ED 跌倒的干预措施。实施了一项综合计划，其中包括 ED 特定的跌倒风险评估工具、远程视频监控（RVM）、担架警报和强大的患者安全文化等干预措施。将患者跌倒和跌倒受伤作为结果指标进行跟踪。
经过对因果关系进行数据驱动分析、选择关键干预措施、员工教育以及持续关注 2 年后，该部门的跌倒率下降了 27%，跌倒受伤率下降了 66%。
多因素方法是降低急诊室患者跌倒的有效策略。
