Trial of Proximity Alarms to Reduce Patient Falls

描述（由申请人提供）：接近报警系统被推广为减少医院中的福尔斯和减少使用身体约束的方法，但尚未对其进行严格测试。拟议研究的目标是测试一种干预措施，以在田纳西州孟菲斯的一家拥有652张床位的城市社区医院卫理公会大学医院（M-UH）的住院患者中引入和实施关于福尔斯风险的接近警报。该医院为不同的成年患者群体提供初级到三级护理。 我们建议使用16个25张病床的一般内科手术护理单位在M-UH进行的组随机试验来测试干预。根据最初3个月观察期内发生的福尔斯率，将护理单位随机分配到2个区组内。在15个月的干预中，8个护理单元将被随机分配接受基于警报的干预，8个将利用现有的护理方法来最大限度地减少福尔斯。干预单位将获得足够的近距离报警监测系统供应，以适用于护理人员认为有福尔斯高风险的所有患者。一个由护士冠军、老年病学家和生物医学仪器专家组成的执行小组将对干预单位进行培训和定期跟踪，以解决与使用警报有关的技术问题。主要结局指标，患者福尔斯，将由护士经理使用我们开发的收集患者的方法前瞻性地确定（例如，方向和姿势血压）以及以标准化方式收集的环境数据。 本研究的主要目的是确定接近报警监测是否减少了福尔斯。我们设计的研究旨在检验这样一个假设，即与对照组相比，干预组患者的福尔斯跌倒率将降低25%。次要目的是确定接近报警监测是否减少了物理约束的使用，或降低了患者护理成本。 这将是第一个方法学上合理的研究，以评估这种有前途的方法，以减少福尔斯在医院。无论警报是否成功地减少了福尔斯，这项拟议研究的结果都有可能广泛影响购买决策和与急性护理环境中的跌倒预防相关的临床实践。

DESCRIPTION (provided by applicant): Proximity alarm systems are promoted as an approach to reduce falls and decrease use of physical restraints in hospitals, but they have not been tested rigorously. The goal of the proposed study is to test an intervention to introduce and implement proximity alarms on the risk of falls in hospitalized patients at Methodist-University Hospital (M-UH), a 652-bed urban community hospital in Memphis, Tennessee. The hospital provides primary to tertiary care to a diverse adult patient population. We propose to test the intervention using a group randomized trial conducted on 16 25-bed general medical-surgical nursing units at M-UH. Nursing units will be randomized within blocks of 2 based on rates of falls that occur during an initial 3-month observation period. Over a 15-month intervention, 8 nursing units will be randomized to receive the alarm-based intervention, and 8 will utilize existing nursing care methods to minimize falls. Intervention units will receive an adequate supply of proximity alarm monitoring systems to apply to all patients considered by nursing staff to be at high risk for falls. An implementation team, consisting of a nurse-champion, geriatrician and biomedical instrumentation specialist, will train and conduct regular follow-up on intervention units to address technical issues related to use of the alarms. The primary outcome measure, patient falls, will be ascertained prospectively by a nurse-manager using a method we have developed to collect patient (e.g., orientation and postural blood pressure) and environmental data collected in a standardized manner. The primary aim of the study is to determine whether proximity alarm monitoring reduces falls. We have designed the study to test the hypothesis that patient falls will be 25% lower on intervention units compared to control units. The secondary aims are to determine whether proximity alarm monitoring reduces the use of physical restraints, or decreases patient care costs. This will be the first methodologically sound study to evaluate this promising approach to reducing falls in hospitals. Whether or not alarms successfully reduce falls, findings from this proposed study have the potential to widely impact purchasing decisions and clinical practice related to fall prevention in acute-care settings.