Hospital Fall Prevention: A Systematic Review of Implementation, Components, Adherence, and Effectiveness
Hospital Fall Prevention: A Systematic Review of Implementation, Components, Adherence, and Effectiveness
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DOI：
10.1111/jgs.12169
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发表时间：
2013-04-01
影响因子：
6.3
通讯作者：
Ganz, David A.
中科院分区：
文献类型：
--
作者：
Hempel, Susanne;Newberry, Sydne;Ganz, David A.
目标 系统记录美国急症护理医院已发布的跌倒预防方法的实施、组成部分、比较、遵守情况和有效性。设计系统审查。研究是通过现有评论、搜索五个电子数据库、筛选参考列表以及联系主题专家以获取截至 2011 年 8 月发表的研究而确定的。设置美国急症护理医院。参与者研究报告干预组和同期（例如对照试验）或历史比较（例如前后研究）的院内跌倒情况。干预 跌倒预防干预措施。测量 发生率比率（IRR，干预后或治疗组跌倒率与干预前或对照组跌倒率的比率）和研究细节的评级。结果 59 项研究符合纳入标准。实施策略的记录很少（17% 根本没有），包括员工教育、建立委员会、寻求领导支持以及偶尔的持续质量改进技术。大多数干预措施（81%）包括多个组成部分（例如，风险评估（通常未经验证）、视觉风险警报、患者教育、护理查房、离床警报和跌倒后评估）。 54% 的人没有报告对照组应用的跌倒预防措施，39% 的人既没有报告保真度数据，也没有描述遵守策略，例如定期审核和反馈以确保完成护理流程。只有 45% 的同期对照研究和 15% 的历史对照研究报告了足够的数据来比较跌倒率。汇总后干预发生率 (IRR) 为 0.77（95% 置信区间=0.521.12，P=.17；八项研究；I2：94%）。元回归显示实施强度、干预复杂性、比较信息或依从性水平与 IRR 之间没有系统关联。结论 存在有希望的方法，但需要更好地报告结果、实施、依从性、干预组成部分和对照组信息，以建立医院如何成功预防跌倒的证据。
Objectives To systematically document the implementation, components, comparators, adherence, and effectiveness of published fall prevention approaches in U.S. acute care hospitals. Design Systematic review. Studies were identified through existing reviews, searching five electronic databases, screening reference lists, and contacting topic experts for studies published through August 2011. Setting U.S. acute care hospitals. Participants Studies reporting in-hospital falls for intervention groups and concurrent (e.g., controlled trials) or historic comparators (e.g., beforeafter studies). Intervention Fall prevention interventions. Measurements Incidence rate ratios (IRR, ratio of fall rate postintervention or treatment group to the fall rate preintervention or control group) and ratings of study details. Results Fifty-nine studies met inclusion criteria. Implementation strategies were sparsely documented (17% not at all) and included staff education, establishing committees, seeking leadership support, and occasionally continuous quality improvement techniques. Most interventions (81%) included multiple components (e.g., risk assessments (often not validated), visual risk alerts, patient education, care rounds, bed-exit alarms, and postfall evaluations). Fifty-four percent did not report on fall prevention measures applied in the comparison group, and 39% neither reported fidelity data nor described adherence strategies such as regular audits and feedback to ensure completion of care processes. Only 45% of concurrent and 15% of historic control studies reported sufficient data to compare fall rates. The pooled postintervention incidence rate ratio (IRR) was 0.77 (95% confidence interval=0.521.12, P=.17; eight studies; I2: 94%). Meta-regressions showed no systematic association between implementation intensity, intervention complexity, comparator information, or adherence levels and IRR. Conclusion Promising approaches exist, but better reporting of outcomes, implementation, adherence, intervention components, and comparison group information is necessary to establish evidence on how hospitals can successfully prevent falls.