Use of Incident Reports to Assess Falls in Nursing Homes

描述（由申请人提供）：本论文研究的目的是测试系统引导、菜单驱动的事件报告系统 (MDIRS) 对疗养院 (NH) 跌倒后评估过程的效果。体弱的新罕布什尔州居民跌倒是一个常见且可以预防的问题，会导致不利的经济、医疗和心理后果。新罕布什尔州 170 万居民中约有一半每年都会跌倒。当新罕布什尔州居民跌倒时，持有执照的护士会在医疗记录和事故报告中记录该事件。传统上，事件报告在 NHs 中具有双重目的——风险管理和责任，但很少用于质量改进。事件报告系统已被成功用作减少错误和提高多个学科安全性的模型，但其在提高 NH 护理质量方面的应用尚未得到检验。本研究旨在改进跌倒事件报告的内容和系统结构，总体目标是提高护士为新罕布什尔州居民提供的护理质量。第二个目标是探索将 MDIRS 瀑布信息输入计算机软件程序的可行性，以促进质量改进计划的数据汇总分析。这项研究的广泛、长期目标是为旨在提高新罕布什尔州居民安全的研究计划奠定基础。该研究是一项为期六个月的前测后测实验设计，旨在检验 MDIRS 对 NH 跌倒后评估过程的影响。该候选人已成功招募亚特兰大大都会地区的 6 名 NH（3 名干预；3 名对照）参与该研究。将检查六个月研究期间跌倒的居民的医疗记录文件。通过根据临床实践指南进行结构化护理流程审核，候选人将测试 NH 工作人员利用 MDIRS 干预措施是否改进了 NH 工作人员在跌倒后评估期间系统评估住院医师的方式。这项研究的结果可能会改进 NH 跌倒后评估的方法。

DESCRIPTION (provided by the applicant): The purpose of this dissertation research is to test the effect of a systematically guided, menu-driven incident reporting system (MDIRS) on the post fall evaluation process in nursing homes (NHs). Falls among frail NH residents are a common and potentially preventable problem that results in adverse economic, medical, and psychological consequences. Approximately one-half of the 1.7 million NH residents fall annually. When a NH resident falls, the licensed nurse documents the incident both in the medical record and incident report. Traditionally, the incident report serves a dual purpose in NHs-risk management and liability, but it is seldom used for quality improvement. Incident reporting systems have been successfully used as a model to reduce errors and improve safety in several disciplines, but their use in improving the quality of care in NHs has not been examined. This study aims to improve the content and systematic structure of a falls incident report with the overall goal of enhancing the quality of care that nurses provide to NH residents. A secondary goal is to explore the feasibility in entering the MDIRS falls information in a computer software program to facilitate aggregate analysis of data for quality improvement initiatives. The broad, long term objective of this study is to provide a foundation for a program of research aimed at improving the safety among NH residents. The study is a six-month pretest-posttest experimental design to examine the effect of the MDIRS on the post-fall evaluation process in NHs. The candidate has successfully recruited six NHs (3 intervention; 3 control) in the metropolitan Atlanta area to participate in the study. Medical record documentation of residents who fall during the six month study period will be examined. By conducting a structured process-of-care audit based on clinical practice guidelines, the candidate will test whether the NH staff utilizing the MDIRS intervention improves how NH staff systematically assess residents in the post-fall evaluation period. The results of this study may lead to improved methods for post-fall assessment in NHs.