Unit-level variation in bed alarm use in US hospitals.
Unit-level variation in bed alarm use in US hospitals.
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美国医院床位警报器使用的单位级别差异。
DOI：
10.1002/nur.22049
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发表时间：
2020
影响因子：
2
通讯作者：
Shorr,RonaldI
中科院分区：
文献类型：
--
作者：
Staggs,VincentS;Turner,Kea;Potter,Catima;Cramer,Emily;Dunton,Nancy;Mion,LorraineC;Shorr,RonaldI
床和椅子报警器在医院中被广泛使用，尽管缺乏有效性和意想不到的负面后果。在这项横断面观察性研究中，我们检查了警报流行率以及患者和单位层面因素对参与国家护理质量指标数据库®的57家美国医院的59个急诊护理单位的警报使用的贡献。护理单位工作人员报告了1，489例患者的患者级跌倒风险和跌倒预防措施数据。使用逻辑回归估计报警使用的患者水平倾向评分。将每个装置的预期报警使用（定义为平均患者报警倾向评分）与观察到的报警使用率进行比较。超过三分之一接受评估的患者在“开启”位置发出警报。与较高报警使用几率相关的患者特征包括近期跌倒、需要截肢辅助、移动性判断差和精神状态改变。观察到的单元报警使用率范围为0%至100%（中位数33%，第10百分位数5%，第90百分位数67%）。预期报警使用变化较小（中位数31%，第10百分位数27%，第90百分位数45%）。观察到的报警使用中只有29%的变化是由预期的报警使用引起的。单元分配是比患者级跌倒风险变量更强的报警使用预测因子。报警器的使用很常见，各医院之间差异很大，患者跌倒风险因素无法完全解释报警器的使用;报警器的使用主要由单位实践驱动。警报使用过于频繁和不加区别，需要指导优化警报使用，以减少噪音并鼓励适当患者的移动性。
Bed and chair alarms are widely used in hospitals, despite lack of effectiveness and unintended negative consequences. In this cross‐sectional, observational study, we examined alarm prevalence and contributions of patient‐ and unit‐level factors to alarm use on 59 acute care nursing units in 57 US hospitals participating in the National Database of Nursing Quality Indicators®. Nursing unit staff reported data on patient‐level fall risk and fall prevention measures for 1,489 patients. Patient‐level propensity scores for alarm use were estimated using logistic regression. Expected alarm use on each unit, defined as the mean patient propensity‐for‐alarm score, was compared with the observed rate of alarm use. Over one‐third of patients assessed had an alarm in the “on” position. Patient characteristics associated with higher odds of alarm use included recent fall, need for ambulation assistance, poor mobility judgment, and altered mental status. Observed rates of unit alarm use ranged from 0% to 100% (median 33%, 10th percentile 5%, 90th percentile 67%). Expected alarm use varied less (median 31%, 10th percentile 27%, and 90th percentile 45%). Only 29% of variability in observed alarm use was accounted for by expected alarm use. Unit assignment was a stronger predictor of alarm use than patient‐level fall risk variables. Alarm use is common, varies widely across hospitals, and cannot be fully explained by patient fall risk factors; alarm use is driven largely by unit practices. Alarms are used too frequently and too indiscriminately, and guidance is needed for optimizing alarm use to reduce noise and encourage mobility in appropriate patients.