Evaluation of a Patient-Centered Fall-Prevention Tool Kit to Reduce Falls and Injuries: A Nonrandomized Controlled Trial.
Evaluation of a Patient-Centered Fall-Prevention Tool Kit to Reduce Falls and Injuries: A Nonrandomized Controlled Trial.
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DOI：
10.1001/jamanetworkopen.2020.25889
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发表时间：
2020-11-02
影响因子：
13.8
通讯作者：
Bates DW
中科院分区：
文献类型：
--
作者：
Dykes PC;Burns Z;Adelman J;Benneyan J;Bogaisky M;Carter E;Ergai A;Lindros ME;Lipsitz SR;Scanlan M;Shaykevich S;Bates DW
这项非随机对照试验评估了波士顿和纽约市 3 个学术医疗中心实施由护士主导、以患者为中心的跌倒预防工具包是否与跌倒和跌倒相关伤害发生率降低相关。吸引患者和家属参与的跌倒预防工具包是否与减少跌倒有关？在这项非随机对照试验中，包括来自 3 个学术医疗中心内 14 个医疗单位的 37-231 名患者，中断的时间序列发现，实施跌倒预防工具包与住院患者跌倒总体减少 15% 和伤害性跌倒减少 34% 具有统计学意义相关。研究结果表明，在住院期间支持患者参与跌倒预防过程的工具可能与跌倒和跌倒相关伤害的减少有关。跌倒是医院中可预防伤害的主要原因，也是经常报告的严重不良事件。住院治疗会增加跌倒和严重受伤的风险，包括髋部骨折、硬膜下血肿，甚至死亡。多因素策略已被证明可以减少急症护理医院的跌倒，但缺乏医院预防跌倒相关伤害的证据。评估让患者和家属在住院期间参与跌倒预防过程的跌倒预防工具包是否与减少跌倒和伤害性跌倒有关。这项采用阶梯式楔形设计的非随机对照试验于 2015 年 11 月 1 日至 2018 年 10 月 31 日期间在波士顿和纽约市 3 个学术医疗中心内的 14 个医疗单位进行。所有在参与单位住院的成年住院患者均纳入分析。由护士主导的跌倒预防工具包，将基于证据的预防干预措施与患者特定的跌倒风险因素联系起来，旨在将患者和家人的持续参与纳入跌倒预防过程中。主要结果是研究期间目标单位每 1000 个患者日的患者跌倒率。次要结果是每 1000 个患者日的跌倒受伤率。在中断时间序列期间，对 37~231 名患者进行了评估，其中包括干预前 17~948 名患者（平均 [SD] 年龄，60.56 [18.30] 岁；9723 [54.17%] 女性）和干预后 19~283 名患者（平均 [SD] 年龄，60.92 [18.10] 岁；10~325 名患者） [53.54%] 女性）。与实施前相比，实施跌倒预防工具包后，跌倒发生率总体下降了 15%（每 1000 个患者日 2.92 次跌倒与 2.49 次跌倒 [95% CI，每 1000 个患者日 2.06-3.00 次跌倒]；调整后比率 0.85；95% CI，0.75-0.96；P = .01），并且调整后伤害性跌倒减少 34% （每 1000 个患者日有 0.73 次伤害性跌倒与 0.48 次伤害性跌倒[95% CI，每 1000 个患者日有 0.34-0.70 次伤害性跌倒]；调整后的比率，0.66；95% CI，0.53-0.88；P = .003）。在这项非随机对照试验中，跌倒预防工具包的实施与跌倒和相关伤害的显着减少有关。患者与护理团队的合作似乎有利于预防跌倒和跌倒相关伤害。 ClinicalTrials.gov 标识符：NCT02969343
This nonrandomized controlled trial assesses whether implementation of a nurse-led, patient-centered tool kit for fall prevention was associated with a reduction in rates of falls and fall-related injuries in 3 academic medical centers in Boston and New York City. Is a fall-prevention tool kit that engages patients and families associated with a reduction in falls? In this nonrandomized controlled trial including 37 231 patients from 14 medical units within 3 academic medical centers, an interrupted time series found that implementation of a fall-prevention tool kit was associated with a statistically significant 15% reduction in overall inpatient falls and a 34% reduction in injurious falls. The findings suggest that tools to support patient engagement throughout hospitalization in the fall-prevention process may be associated with a reduction in falls and fall-related injuries. Falls represent a leading cause of preventable injury in hospitals and a frequently reported serious adverse event. Hospitalization is associated with an increased risk for falls and serious injuries including hip fractures, subdural hematomas, or even death. Multifactorial strategies have been shown to reduce falls in acute care hospitals, but evidence for fall-related injury prevention in hospitals is lacking. To assess whether a fall-prevention tool kit that engages patients and families in the fall-prevention process throughout hospitalization is associated with reduced falls and injurious falls. This nonrandomized controlled trial using stepped wedge design was conducted between November 1, 2015, and October 31, 2018, in 14 medical units within 3 academic medical centers in Boston and New York City. All adult inpatients hospitalized in participating units were included in the analysis. A nurse-led fall-prevention tool kit linking evidence-based preventive interventions to patient-specific fall risk factors and designed to integrate continuous patient and family engagement in the fall-prevention process. The primary outcome was the rate of patient falls per 1000 patient-days in targeted units during the study period. The secondary outcome was the rate of falls with injury per 1000 patient-days. During the interrupted time series, 37 231 patients were evaluated, including 17 948 before the intervention (mean [SD] age, 60.56 [18.30] years; 9723 [54.17%] women) and 19 283 after the intervention (mean [SD] age, 60.92 [18.10] years; 10 325 [53.54%] women). There was an overall adjusted 15% reduction in falls after implementation of the fall-prevention tool kit compared with before implementation (2.92 vs 2.49 falls per 1000 patient-days [95% CI, 2.06-3.00 falls per 1000 patient-days]; adjusted rate ratio 0.85; 95% CI, 0.75-0.96; P = .01) and an adjusted 34% reduction in injurious falls (0.73 vs 0.48 injurious falls per 1000 patient-days [95% CI, 0.34-0.70 injurious falls per 1000 patient-days]; adjusted rate ratio, 0.66; 95% CI, 0.53-0.88; P = .003). In this nonrandomized controlled trial, implementation of a fall-prevention tool kit was associated with a significant reduction in falls and related injuries. A patient–care team partnership appears to be beneficial for prevention of falls and fall-related injuries. ClinicalTrials.gov Identifier: NCT02969343
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影响因子：
3
作者：
Kutney-Lee A;Stimpfel AW;Sloane DM;Cimiotti JP;Quinn LW;Aiken LH
通讯作者：
Aiken LH
影响因子：
4.2
作者：
Lucero, Robert J.;Lake, Eileen T.;Aiken, Linda H.
通讯作者：
Aiken, Linda H.
DOI：
10.1016/j.jcjq.2017.05.002
发表时间：
2017-08-01
影响因子：
2.3
作者：
Dykes, Patricia C.;Duckworth, Megan;Scanlan, Maureen
通讯作者：
Scanlan, Maureen
DOI：
10.1093/gerona/glaa004
发表时间：
2020-10-01
影响因子：
5.1
作者：
Burns, Zoe;Khasnabish, Srijesa;Dykes, Patricia C.
通讯作者：
Dykes, Patricia C.
影响因子：
--
作者：
Clavelle, Joanne T
通讯作者：
Clavelle, Joanne T