A case-control study of patient, medication, and care-related risk factors for inpatient falls
A case-control study of patient, medication, and care-related risk factors for inpatient falls
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DOI：
10.1111/j.1525-1497.2005.40171.x
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发表时间：
2005-02-01
影响因子：
5.7
通讯作者：
Fraser, VJ
中科院分区：
文献类型：
--
作者：
Krauss, MJ;Evanoff, B;Fraser, VJ
目的：综合分析院内跌倒的潜在危险因素，描述发生福尔斯的情况。设计：病例对照研究。通过与患者和/或护士的访谈以及对不良事件报告、医疗记录和护士工作记录的回顾，收集了关于福尔斯的潜在危险因素和情况的数据。在患者相关、药物和护理相关变量的多变量模型中，与跌倒风险增加显著相关的因素包括：步态/平衡缺陷或下肢问题（校正比值比[aOR]，9.0; 95%置信区间[CI]，2.0 - 41.0），意识模糊（aOR，3.6; 95% CI，1.6 - 8.4），使用镇静剂/催眠药（aOR，4.3; 95% CI，1.6 - 11.5），使用糖尿病药物（aOR，3.2; 95% CI，1.3 - 7.9），增加患者与护士的比例（aOR，1.6; 95%CI，1.2至2.0），和活动水平的“与援助”相比，“浴室厕所”（aOR，8.7; 95%CI，2.3至32.7）。尿或大便频率或失禁具有临界显著性（aOR，2.3; 95%CI，0.99至5.6）。有一个或多个侧轨升高与跌倒风险降低相关（aOR，0.006; 95%CI，0.001至0.024）。结论：患者的健康状况，特别是异常步态或下肢问题，药物，以及护理相关因素，增加跌倒的风险。跌倒预防计划应针对具有这些风险因素的患者，并考虑使用频繁的定期动员和活动，并尽量减少与跌倒相关的药物的使用。
OBJECTIVE: To comprehensively analyze potential risk factors for falling in the hospital and describe the circumstances surrounding falls.DESIGN: Case-control study. Data on potential risk factors and circumstances of the falls were collected via interviews with patients and/or nurses and review of adverse event reports, medical records, and nurse staffing records.SETTING: Large urban academic hospital.PATIENTS: Ninety-eight inpatients who fell and 318 controls matched on approximate length of stay until the index fall.MEASUREMENTS AND MAIN RESULTS: In a multivariate model of patient-related, medication, and care-related variables, factors that were significantly associated with an increased risk of falling included: gait/balance deficit or lower extremity problem ( adjusted odds ratio [aOR], 9.0; 95% confidence interval [CI], 2.0 to 41.0), confusion (aOR, 3.6; 95% CI, 1.6 to 8.4), use of sedatives/hypnotics (aOR, 4.3; 95% CI, 1.6 to 11.5), use of diabetes medications (aOR, 3.2; 95% CI, 1.3 to 7.9), increasing patient-to-nurse ratio (aOR, 1.6; 95% CI, 1.2 to 2.0), and activity level of "up with assistance'' compared with "bathroom privileges'' (aOR, 8.7; 95% CI, 2.3 to 32.7). Urinary or stool frequency or incontinence was of borderline significance (aOR, 2.3; 95% CI, 0.99 to 5.6). Having one or more side rails raised was associated with a decreased risk of falling (aOR, 0.006; 95% CI, 0.001 to 0.024).CONCLUSIONS: Patient health status, especially abnormal gait or lower extremity problems, medications, as well as care-related factors, increase the risk of falling. Fall prevention programs should target patients with these risk factors and consider using frequently scheduled mobilization and toileting, and minimizing use of medications related to falling.