6-PACK programme to decrease fall injuries in acute hospitals: cluster randomised controlled trial.
6-PACK programme to decrease fall injuries in acute hospitals: cluster randomised controlled trial.
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DOI：
10.1136/bmj.h6781
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发表时间：
2016-01-26
期刊：
影响因子：
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通讯作者：
Kamar J
中科院分区：
文献类型：
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作者：
Barker AL;Morello RT;Wolfe R;Brand CA;Haines TP;Hill KD;Brauer SG;Botti M;Cumming RG;Livingston PM;Sherrington C;Zavarsek S;Lindley RI;Kamar J
目的评价6件装护理方案对急诊病房坠落及坠落伤的治疗效果。设计：整群随机对照试验。背景是六家澳大利亚医院。参与者包括在试验期间住进24个急性病房的所有患者。参与病房的干预措施被随机分配到接受护士领导的6人计划或超过12个月的常规护理。这项由6个人组成的计划包括一个跌倒风险工具和六种干预措施中的一种或多种的个人化使用：“跌倒警报”标志、在卫生间监督病人、确保病人的助行器触手可及、如厕方法、使用低矮床和使用床/椅警报器。主要结果指标是每1000个占用床日中的跌倒和跌伤。结果：在试验期间，16个内科病房和8个外科病房共有46个 245人入院。由于许多人不止一次入院，这代表了31名 411名患者。干预病房和对照病房的患者特征和住院时间相似。干预病房使用6件套程序组件的比例高于对照病房(发生率比3.0 5，95%可信区间2.14至4.34；P<；0.001)。干预组和对照组跌倒发生率(发生率比1.0 4，0.78：1.37；P=0.796)和坠落伤发生率(0.96，0.72：1.2 7；P=0.766)相似。结论：在引入6包计划后，预防跌倒的做法发生了积极的变化。然而，在跌倒或跌伤方面，两组之间没有看到差异。显示急性病房预防跌倒干预措施有效性的高质量证据仍然缺乏。医院内跌倒的问题迫切需要新的解决方案。试验注册澳大利亚新西兰临床试验注册ACTRN12611000332921。
Objective To evaluate the effect of the 6-PACK programme on falls and fall injuries in acute wards. Design Cluster randomised controlled trial. Setting Six Australian hospitals. Participants All patients admitted to 24 acute wards during the trial period. Interventions Participating wards were randomly assigned to receive either the nurse led 6-PACK programme or usual care over 12 months. The 6-PACK programme included a fall risk tool and individualised use of one or more of six interventions: “falls alert” sign, supervision of patients in the bathroom, ensuring patients’ walking aids are within reach, a toileting regimen, use of a low-low bed, and use of a bed/chair alarm. Main outcome measures The co-primary outcomes were falls and fall injuries per 1000 occupied bed days. Results During the trial, 46 245 admissions to 16 medical and eight surgical wards occurred. As many people were admitted more than once, this represented 31 411 individual patients. Patients’ characteristics and length of stay were similar for intervention and control wards. Use of 6-PACK programme components was higher on intervention wards than on control wards (incidence rate ratio 3.05, 95% confidence interval 2.14 to 4.34; P<0.001). In all, 1831 falls and 613 fall injuries occurred, and the rates of falls (incidence rate ratio 1.04, 0.78 to 1.37; P=0.796) and fall injuries (0.96, 0.72 to 1.27; P=0.766) were similar in intervention and control wards. Conclusions Positive changes in falls prevention practice occurred following the introduction of the 6-PACK programme. However, no difference was seen in falls or fall injuries between groups. High quality evidence showing the effectiveness of falls prevention interventions in acute wards remains absent. Novel solutions to the problem of in-hospital falls are urgently needed. Trial registration Australian New Zealand Clinical Trials Registry ACTRN12611000332921.