Effects of an Intervention to Increase Bed Alarm Use to Prevent Falls in Hospitalized Patients A Cluster Randomized Trial
Effects of an Intervention to Increase Bed Alarm Use to Prevent Falls in Hospitalized Patients A Cluster Randomized Trial
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DOI：
10.7326/0003-4819-157-10-201211200-00005
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发表时间：
2012-11-20
影响因子：
39.2
通讯作者：
Miller, Stephen T.
中科院分区：
文献类型：
--
作者：
Shorr, Ronald I.;Chandler, A. Michelle;Miller, Stephen T.
背景：旨在预防医院跌倒的床报警系统尚未经过正式评估。目的：调查旨在增加床报警器使用的干预措施是否可以减少医院跌倒和相关事件。设计：为期 18 个月的配对、整群随机试验。护理单位是根据基线下降率由计算机随机分配的。患者和结果评估者对单元分配不知情；结果评估者可能已经不设盲了。 （ClinicalTrials.gov 注册号：NCT00183053）地点：城市社区医院的 16 个护理单位。患者：普通内科、外科和专科单位的 27 672 名住院患者。干预：教育、培训和技术支持，以促进使用标准病床报警系统（干预单位）；可用床警报，但未正式推广或支持（控制单位）。测量：每 1000 个患者日跌倒变化的前后差异（主要终点）；跌倒的患者数量、跌倒相关伤害以及被约束的患者数量（次要终点）。 结果：干预设备上警报使用率为每 1000 个患者日 64.41 天，控制设备上每 1000 个患者日警报使用率为 1.79 天（P = 0.004）。与对照组相比，每 1000 个患者日的跌倒率变化（风险比为 1.09 [95% CI，0.85 至 1.53]；差异为 0.41 [CI，-1.05 至 2.47]，这对应于对照与干预单元中跌倒的更大差异）或跌倒患者数量、受伤跌倒率或干预单元中受到身体约束的患者数量没有差异局限性：该研究是在单个地点进行的，与最初的设计相比，效果稍显不足。结论：一项旨在增加城市医院床警报使用的干预措施增加了警报的使用，但对跌倒相关事件或身体约束的使用没有统计或临床显着影响。主要资金来源：国家老龄化研究所。
Background: Bed alarm systems intended to prevent hospital falls have not been formally evaluated.Objective: To investigate whether an intervention aimed at increasing bed alarm use decreases hospital falls and related events.Design: Pair-matched, cluster randomized trial over 18 months. Nursing units were allocated by computer-generated randomization on the basis of baseline fall rates. Patients and outcome assessors were blinded to unit assignment; outcome assessors may have become unblinded. (ClinicalTrials.gov registration number: NCT00183053)Setting: 16 nursing units in an urban community hospital.Patients: 27 672 inpatients in general medical, surgical, and specialty units.Intervention: Education, training, and technical support to promote use of a standard bed alarm system (intervention units); bed alarms available but not formally promoted or supported (control units).Measurements: Pre-post difference in change in falls per 1000 patient-days (primary end point); number of patients who fell, fall-related injuries, and number of patients restrained (secondary end points).Results: Prevalence of alarm use was 64.41 days per 1000 patient-days on intervention units and 1.79 days per 1000 patient-days on control units (P = 0.004). There was no difference in change in fall rates per 1000 patient-days (risk ratio, 1.09 [ 95% CI, 0.85 to 1.53]; difference, 0.41 [CI, -1.05 to 2.47], which corresponds to a greater difference in falls in control vs. intervention units) or in the number of patients who fell, injurious fall rates, or the number of patients physically restrained on intervention units compared with control units.Limitation: The study was conducted at a single site and was slightly underpowered compared with the initial design.Conclusion: An intervention designed to increase bed alarm use in an urban hospital increased alarm use but had no statistically or clinically significant effect on fall-related events or physical restraint use.Primary Funding Source: National Institute on Aging.