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的指导下，菜单驱动的事件报告系统（MDIRS）的影响后下降评估过程中的养老院（NH）。体弱的NH居民中的福尔斯是一个常见的和潜在的可预防的问题，导致不利的经济，医疗和心理后果。大约有一半的170万NH居民每年下降。当一个NH居民福尔斯跌倒时，有执照的护士在医疗记录和事件报告中都记录了这一事件。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。事件报告系统已成功地用作减少错误和提高安全性的模型，但其在提高护理质量方面的作用尚未得到研究。本研究旨在改善福尔斯事件报告的内容和系统结构，其总体目标是提高护士为NH居民提供的护理质量。次要目标是探索将MDIRS福尔斯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，长期的目标是为旨在提高NH居民安全的研究计划提供基础。本研究是一个为期六个月的前测-后测的实验设计，旨在考察MDIRS对NHS秋季后评估过程的影响。候选人已成功招募了亚特兰大大都市地区的6名NH（3名干预组; 3名对照组）参与研究。将检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工作人员在秋季后评估期间系统评估居民的方式。这项研究的结果可能会导致改进的方法，为跌倒后的评估在NHS。

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.