Inpatient Fall Prevention Programs as a Patient Safety Strategy A Systematic Review
Inpatient Fall Prevention Programs as a Patient Safety Strategy A Systematic Review
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DOI：
10.7326/0003-4819-158-5-201303051-00005
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发表时间：
2013-03-05
影响因子：
39.2
通讯作者：
Shekelle, Paul G.
中科院分区：
文献类型：
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作者：
Miake-Lye, Isomi M.;Hempel, Susanne;Shekelle, Paul G.
跌倒在住院病人中很常见。多项综述（包括涉及 19 项研究的 4 项荟萃分析）表明，预防住院患者跌倒的多成分计划可将跌倒的相对风险降低多达 30%。本次更新审查的目的是重新评估急性护理环境中跌倒预防计划的益处和危害，并确定与成功实施这些计划相关的因素。我们从 2005 年到 2012 年 9 月利用 PubMed 寻找新的证据。两项新的大型随机对照试验支持了现有荟萃分析的结论。尚未确定最佳的组件包。没有系统地检查其危害，但潜在的危害包括增加束缚和镇静药物的使用以及减少动员患者的努力。十一项研究表明，以下主题与成功实施相关：领导支持、一线员工参与计划设计、多学科委员会对预防计划的指导、试点测试干预措施、使用信息技术系统提供跌倒数据、员工教育和培训以及对跌倒预防的虚无主义态度的改变。未来的研究将通过确定特定患者的最佳干预措施组合以及确定有效性是否更多地依赖于各成分的组合或某些实施策略的使用来增进知识。安实习医生。 2013；158：390-396。 www.annals.org
Falls are common among inpatients. Several reviews, including 4 meta-analyses involving 19 studies, show that multicomponent programs to prevent falls among inpatients reduce relative risk for falls by as much as 30%. The purpose of this updated review is to reassess the benefits and harms of fall prevention programs in acute care settings and to identify factors associated with successful implementation of these programs. We searched for new evidence using PubMed from 2005 to September 2012. Two new, large, randomized, controlled trials supported the conclusions of the existing meta-analyses. An optimal bundle of components was not identified. Harms were not systematically examined, but potential harms included increased use of restraints and sedating drugs and decreased efforts to mobilize patients. Eleven studies showed that the following themes were associated with successful implementation: leadership support, engagement of front-line staff in program design, guidance of the prevention program by a multidisciplinary committee, pilot-testing interventions, use of information technology systems to provide data about falls, staff education and training, and changes in nihilistic attitudes about fall prevention. Future research would advance knowledge by identifying optimal bundles of component interventions for particular patients and by determining whether effectiveness relies more on the mix of the components or use of certain implementation strategies. Ann Intern Med. 2013;158:390-396. www.annals.org