Fall rates in hospital rehabilitation units after individualised patient and staff education programmes: a pragmatic, stepped-wedge, cluster-randomised controlled trial
Fall rates in hospital rehabilitation units after individualised patient and staff education programmes: a pragmatic, stepped-wedge, cluster-randomised controlled trial
复制标题
DOI：
10.1016/s0140-6736(14)61945-0
复制
发表时间：
2015-06-27
期刊：
影响因子：
168.9
通讯作者：
Haines, Terry P.
中科院分区：
文献类型：
--
作者：
Hill, Anne-Marie;McPhail, Steven M.;Haines, Terry P.
背景 跌倒是医院报告的最常见的不良事件。我们检查了对患者进行个性化跌倒预防教育的有效性，并以病房级计划的形式提供给工作人员培训和反馈。方法澳大利亚综合医院的八个康复单位参与了这项为期 50 周的阶梯楔形、整群随机研究。通过使用计算机生成的随机分配序列，将单元随机分配到干预组或对照组。我们纳入了研究期间入院的简易精神状态检查 (MMSE) 分数超过 23/30 的患者，除了常规护理外，还接受训练有素的健康专业人员基于健康行为改变原则的个性化教育。我们向接受过培训以支持患者采用策略的工作人员提供有关患者目标、有关病房环境的反馈以及参与跌倒预防策略的感知障碍的信息。共同主要结果指标是每 1000 个患者日的患者跌倒率以及跌倒患者的比例。所有分析均按意向治疗进行。该试验已在澳大利亚新西兰临床试验登记处注册，编号为 ACTRN12612000877886）。调查结果 2013 年 1 月 13 日至 12 月 27 日期间，8 个病房共收治了 3606 名患者（n=1983 名对照期；n=1623 名干预期）。跌倒次数较少（n=196，7.80/1000 患者天 vs n=380，13.78/1000 患者天，调整后比率 0.60 [稳健 95% CI 0.42-0.94]，p=0.003），受伤次数较少（n=66，2.63/1000 患者天 vs 131， 4.75/1000 患者天，0.65 [稳健 95% CI 0.42-0.88]，p=0.006），下降者（n=136 [8.38%] vs n=248 [12.51%] 调整比值比 0.55 [稳健 95% CI 0.38 至 0.81]， p=0.003）干预组与对照组相比。住院时间没有显着差异（干预中位时间为 11 天 [IQR 7-19]，对照中位时间为 10 天 [6-18]）。 解释 个性化患者教育计划，加上对常规护理人员的培训和反馈，可降低康复医院单位老年患者跌倒和受伤跌倒的发生率。
Background Falls are the most frequent adverse events that are reported in hospitals. We examined the effectiveness of individualised falls-prevention education for patients, supported by training and feedback for staff, delivered as a ward-level programme.Methods Eight rehabilitation units in general hospitals in Australia participated in this stepped-wedge, cluster-randomised study, undertaken during a 50 week period. Units were randomly assigned to intervention or control groups by use of computer-generated, random allocation sequences. We included patients admitted to the unit during the study with a Mini-Mental State Examination (MMSE) score of more than 23/30 to receive individualised education that was based on principles of changes in health behaviour from a trained health professional, in addition to usual care. We provided information about patients' goals, feedback about the ward environment, and perceived barriers to engagement in falls-prevention strategies to staff who were trained to support the uptake of strategies by patients. The coprimary outcome measures were patient rate of falls per 1000 patient-days and the proportion of patients who were fallers. All analyses were by intention to treat. This trial is registered with the Australian New Zealand Clinical Trials registry, number ACTRN12612000877886).Findings Between Jan 13, and Dec 27, 2013, 3606 patients were admitted to the eight units (n=1983 control period; n=1623 intervention period). There were fewer falls (n=196, 7.80/1000 patient-days vs n=380, 13.78/1000 patient-days, adjusted rate ratio 0.60 [robust 95% CI 0.42-0.94], p=0.003), injurious falls (n=66, 2.63/1000 patient-days vs 131, 4.75/1000 patient-days, 0.65 [robust 95% CI 0.42-0.88], p=0.006), and fallers (n=136 [8.38%] vs n=248 [12.51%] adjusted odds ratio 0.55 [robust 95% CI 0.38 to 0.81], p=0.003) in the intervention compared with the control group. There was no significant difference in length of stay (intervention median 11 days [IQR 7-19], control 10 days [6-18]).Interpretation Individualised patient education programmes combined with training and feedback to staff added to usual care reduces the rates of falls and injurious falls in older patients in rehabilitation hospital-units.