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一个系统指导的、菜单驱动的事件报告系统(MDIRS)对养老院(NHS)跌倒后评估过程的影响。虚弱的NH居民跌倒是一个常见的、可能可以预防的问题，会导致不利的经济、医疗和心理后果。在170万NH居民中，每年大约有一半的人下降。当一名NH居民跌倒时，执业护士会在医疗记录和事故报告中记录该事故。传统上，事故报告在NHS中具有双重目的-风险管理和责任，但很少用于质量改进。事故报告系统已经被成功地用作在几个学科中减少差错和提高安全性的模式，但它们在改善NHS护理质量方面的使用还没有得到审查。本研究旨在改进跌倒事件报告的内容和系统结构，以提高护士为医院住院医生提供的护理质量。第二个目标是探索在计算机软件程序中输入MDIRS Fall信息的可行性，以促进对数据的汇总分析，以改进质量倡议。这项研究的广泛和长期目标是为旨在改善NH居民安全的研究计划提供基础。这项研究是一项为期六个月的前测-后测实验设计，旨在考察MDIRS对NHS跌倒后评估过程的影响。候选人已经成功地招募了亚特兰大大都市区的6名国民健康保险机构(3名干预人员；3名对照人员)参与这项研究。将审查在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的护理过程审计，候选人将测试使用MDIRS干预的NH工作人员是否改善了NH工作人员在秋季评估期内对住院医生进行系统评估的方式。这项研究的结果可能会导致改进NHS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.