Risk Factors for Falls in Hospital In-Patients: A Prospective Nested Case Control Study
Risk Factors for Falls in Hospital In-Patients: A Prospective Nested Case Control Study
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DOI：
10.15171/ijhpm.2019.11
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发表时间：
2019-05-01
影响因子：
3.5
通讯作者：
Yaseri, Mehdi
中科院分区：
文献类型：
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作者：
Najafpour, Zhila;Godarzi, Zahra;Yaseri, Mehdi
背景：患者跌倒被认为是对医院患者安全的挑战，除了增加住院时间和费用外，还可能导致患者重伤甚至死亡。本研究旨在探讨跌倒者与对照组相比危险因素之间的关联。方法：对185名跌倒患者进行前瞻性巢式病例对照研究，并将1141名对照者与同一病房、同一时间的有跌倒风险的患者进行匹配。这项研究是在德黑兰一家拥有 800 张床位的大学教育医院进行的，为期 9 个月。这些数据包括人口统计、合并症、入院详细信息、药物类型、临床状况以及秋季之前或秋季期间的活动。数据收集自临床记录、医院信息系统、错误报告系统和观察，以及对跌倒者、其家人和护理人员（医生、护士等）的访谈。使用多水平分析通过基于时间的匹配进行数据分析。 结果：在包括患者相关、药物和护理相关变量的多水平模型中，与患者跌倒风险增加显着相关的因素包括：较长的住院时间（比值比 [OR] = 1.01；CI = 0.32 至 0.73）、使用化疗药物、镇静剂、抗惊厥药、苯二氮卓类药物和血管紧张素转换药物酶（ACE）抑制剂、视力（OR = 6.93；CI = 4.22至11.38）、平衡状况（OR = 6.41；CI = 4.51至9.11）、手动转移辅助（OR = 8.47；CI = 5.65至12.69）、尿失禁（OR = 8.47，CI = 5.65至12.69）和癌症（OR = 2.86，CI = 1.84-44）。研究发现，这些因素与患者发生跌倒事故的可能性增加有关。跌倒史（OR = 0.48；CI = 1.003 至 1.02）、多种用药（OR = 1.37，CI = 00.85 至 2.2）、卒中（OR = 0.94，CI = 0.44 至 2.02）以及护患比（发生率比 = 1.01，CI = 0.01 至 0.03）等多项特征均不显着。结论：似乎应综合考虑患者相关因素和用药史。此外，在制定干预措施时应考虑患者可改变的临床特征，例如视力改善、提供手动转移辅助、糖尿病控制、定期如厕计划和药物调整。
Background: Patient falls are considered a challenge to the patient's safety in hospitals, which, in addition to increasing the length of stay and costs, may also result in severe injuries or even the death of the patient. This study aims to investigate the associations between risk factors among fallers in comparison with the control group.Methods: A prospective nested case control study was performed on 185 patients who fell and 1141 controls were matched with the patients at risk of fall in the same ward and during the same time. This study was conducted in a university educational hospital in Tehran with 800 beds during a 9-month period. The data included demographics, comorbidities, admission details, types of medication, clinical conditions, and activities before or during the fall. The data was collected from clinical records, hospital information system, error reporting system and observations, and the interviews with the fallers, their families and care givers (physicians, nurses, etc). Data analysis was conducted through time-based matching using a multi-level analysis.Results: In a multilevel model including patient-related, medication, and care-related variables, the factors that were significantly associated with an increased risk of patient falls included: longer length of stay (odds ratio [OR] = 1.01; CI =0.32 to 0.73), using chemotherapy drugs, sedatives, anticonvulsants, benzodiazepines, and angiotensin-converting enzyme (ACE) inhibitors, visual acuity (OR =6.93; CI =4.22 to 11.38), balance condition (OR= 6.41; CI =4.51 to 9.11), manual transfer aid (OR=8.47; CI = 5.65 to 12.69), urinary incontinence (OR= 8.47, CI= 5.65 to 12.69), and cancer (OR = 2.86, CI =1.84-44). These factors were found to be associating with more odds for a falling accident among patients. Several characteristics such as fall history (OR = 0.48; CI= 1.003 to 1.02), poly-pharmacy (OR = 1.37, CI = 00.85 to 2.2), stroke (OR = 0.94, CI = 0.44 to 2.02), and nurse to patient ratio (incidence rate ratio =1.01, CI =0.01 to 0.03) were not significantly associated with falling in hospitals.Conclusion: It seems that a combination of both patient-related factors and history of medication should be considered. Moreover, modifiable clinical characteristics of patients such as vision improvement, provision of manual transfer aid, diabetes control, regular toilet program, and drug modification should be considered during the formulation of interventions.