Pragmatic, Cluster Randomized Trial of a Policy to Introduce Low-Low Beds to Hospital Wards for the Prevention of Falls and Fall Injuries
Pragmatic, Cluster Randomized Trial of a Policy to Introduce Low-Low Beds to Hospital Wards for the Prevention of Falls and Fall Injuries
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DOI：
10.1111/j.1532-5415.2010.02735.x
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发表时间：
2010-03-01
影响因子：
6.3
通讯作者：
Varghese, Paul N.
中科院分区：
文献类型：
--
作者：
Haines, Terry P.;Bell, Rebecca A. R.;Varghese, Paul N.
目的评价在未使用过低矮床的病房引入低矮床预防跌倒和跌倒伤害的效果。设计：这是一项实用的、匹配的、集群随机试验，根据跌倒率对病房进行配对。在干预病房实施低-低床后，对干预病房和对照病房进行为期6个月的观察。在此之前6个月的数据也被收集并纳入分析，以确保干预组和对照组病房之间的可比性。位于澳大利亚昆士兰州的公立医院。参与者：18所公立医院病房的病人。干预措施：在医院病房中，每12人提供一张低矮床，并提供书面指导，以确定跌倒风险最大的患者。测量使用计算机事故报告系统测量医院的跌倒和跌倒伤害。结果干预前对照组和干预病房共入院10937人。引入低-低床位后，干预组病房与对照组病房每1000个床位日的跌倒率无显著差异（广义估计方程系数=0.23,95%置信区间=-0.18-0.65，P= 0.28）。在床上跌倒、跌倒导致受伤和跌倒导致骨折的发生率在两组之间也没有差异。干预组病房在按要求使用低-低床时遇到了一些困难。结论：虽然需要更大规模的研究来确定其对跌倒相关骨折的影响，但引入低床的政策似乎并没有减少跌倒或跌倒伴伤。
OBJECTIVESTo evaluate the efficacy of a policy to introduce low-low beds for the prevention of falls and fall injuries on wards that had not previously accessed low-low beds.DESIGNThis was a pragmatic, matched, cluster randomized trial with wards paired according to rate of falls. Intervention and control wards were observed for a 6-month period after implementation of the low-low beds on the intervention wards. Data from a 6-month period before this were also collected and included in analyses to ensure comparability between intervention and control group wards.SETTINGPublic hospitals located in Queensland, Australia.PARTICIPANTSPatients of 18 public hospital wards.INTERVENTIONProvision of one low-low bed for every 12 on a hospital ward, with written guidance for identifying patients at greatest risk of falls.MEASUREMENTSFalls and fall injuries in the hospital measured using a computerized incident reporting system.RESULTSThere were 10,937 admissions to control and intervention wards combined during the pre-intervention period. There was no significant difference in the rate of falls per 1,000 occupied bed days between intervention and control group wards after the introduction of the low-low beds (generalized estimating equation coefficient=0.23, 95% confidence interval=-0.18-0.65, P=.28). The rate of bed falls, falls resulting in injury, and falls resulting in fracture also did not differ between groups. Some difficulties were encountered in intervention group wards in using the low-low beds as directed.CONCLUSIONA policy for the introduction of low-low beds did not appear to reduce falls or falls with injury, although larger studies would be required to determine their effect on fall-related fractures.