医院跌倒预防干预措施的实施策略：一项系统评价

Implementation strategies of fall prevention interventions in hospitals: a systematic review.

作者信息

Spoon Denise, de Legé Thomas, Oudshoorn Christian, van Dijk Monique, Ista Erwin

机构信息

Internal Medicine, Division of Nursing Science, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands

Internal Medicine, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands.

出版信息

BMJ Open Qual. 2024 Dec 27;13(4):e003006. doi: 10.1136/bmjoq-2024-003006.

DOI:10.1136/bmjoq-2024-003006

PMID:39732472

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11683959/

Abstract

BACKGROUND

The effectiveness of implementing fall prevention interventions (FPI) among hospitalised adults exhibits variability. Our review explored implementation strategies for FPIs, how these strategies are operationalised and their impact on fall rates and adherence.

METHODS

Databases were searched up to October 2024 for studies reporting the implementation of FPIs in hospitalised adults. Studies were eligible if they reported at least one implementation strategy, reported a fall rate per 1000 patient days and had a control group. Implementation strategies were classified using the Expert Recommendations for Implementing Change (ERIC) taxonomy, and operationalised based on the prerequisites of Proctor.

RESULTS

The implementation strategies from the 48 included studies could all be categorised in the existing ERIC strategies. Almost all studies (96%) used at least one implementation strategy from the 'train and educate stakeholders' domain. The second-most used domain was 'develop stakeholder relationships'. The median number of implementation strategies per study was 6 (IQR 4-9). None of the studies reported all prerequisites per individual strategy, we found a median number of prerequisites per strategy of 2 (IQR 1-3). The action was discerned for all implementation strategies, since this was how we identified the implementation strategies. The actor was identified in 47% of the strategies, while all other prerequisites were reported less frequently. After the implementation of FPIs, the median decline in fall rate was 0.9 (IQR -1.8-.3) per 1000 patient days. Across the 17 studies that measured adherence, the median adherence rate to the FPIs was 65% (IQR 29-87).

CONCLUSION

This review emphasises that the documented strategies for implementing FPIs do not provide adequate details in their reporting. This, in turn, hinders clinicians and researchers from optimally guiding their quality improvement projects.

PROSPERO REGISTRATION NUMBER

CRD42018091173.

摘要

背景

在住院成人中实施预防跌倒干预措施（FPI）的效果存在差异。我们的综述探讨了FPI的实施策略、这些策略是如何实施的以及它们对跌倒率和依从性的影响。

方法

检索截至2024年10月的数据库，查找报告在住院成人中实施FPI的研究。如果研究报告了至少一种实施策略、报告了每1000个患者日的跌倒率且有对照组，则该研究符合条件。使用实施变革专家建议（ERIC）分类法对实施策略进行分类，并根据普罗克特的前提条件进行实施。

结果

纳入的48项研究中的实施策略都可以归类到现有的ERIC策略中。几乎所有研究（96%）都使用了“培训和教育利益相关者”领域的至少一种实施策略。第二常用的领域是“发展利益相关者关系”。每项研究实施策略的中位数为6（四分位间距4-9）。没有一项研究报告了每个个体策略的所有前提条件，我们发现每个策略的前提条件中位数为2（四分位间距1-3）。所有实施策略的行动都是明确的，因为这是我们确定实施策略的方式。47%的策略确定了实施者，而其他所有前提条件的报告频率较低。实施FPI后，每1000个患者日跌倒率的中位数下降了0.9（四分位间距-1.8-.3）。在测量依从性的17项研究中，FPI的依从率中位数为65%（四分位间距29-87）。