Linkages between the safety of the hospital bed, patient falls and immobility

描述（由申请人提供）：医院和疗养院的跌倒干预计划表现不佳，许多患者和居民仍然在医院跌倒并受伤。患者环境的一个方面尚未被系统地评估为福尔斯的触发因素，即医院病床。在我们的试点研究中，床的高度，侧栏的不稳定性，以及离开床时缺乏扶手都导致了跌倒风险。在这项拟议的研究中，我们将研究床的高度，侧栏的配置，病人的身体特征和生物力学的力量，施加为病人爬上和下床之间的关系。从急性和长期护理环境中招募的64名参与者将被录像，因为他们与一张床互动，床上装有测量患者力量要求的仪器。生物力学、观察和主观参与者数据将用于确定最佳医院病床高度和侧轨配置，以最大限度地降低跌倒风险并降低损伤风险。生物力学数据将包括进床、出床和床上复位期间的关节扭矩，以及患者、地板表面和病床之间的物理相互作用。将对观察到的问题进行编码，如滑动、平衡检查、不完全进入/退出和接近福尔斯。参与者将提供他们对与不同床高和侧轨配置相关的跌倒风险的主观评估。我们还将研究用于床上移动的侧轨。本研究计划的最终目标是为医院病床提出设计建议，使患者能够安全地进入病床，以最小的努力重新定位自己，以最小的努力在床边站立，并以最佳稳定的步态离开病床。这个拟议的研究项目地址AHRQ的病人安全使命，研究现有的重要医疗保健技术的比较有效性，在这种情况下，医院病床。安全病床的开发将保守地将床边福尔斯跌倒减少10%，从而到2020年每年节省医疗保健系统在预防伤害方面的成本估计为15亿美元。 公共卫生相关性：患者从床上跌落福尔斯导致严重损伤。在这个项目中，我们将探讨床的高度和侧轨的稳定性，因为它们会增加坠落的风险。我们还将检查患者使用侧轨来帮助在床上转动和移动。该研究项目的最终目标是设计一种医院病床，该病床将帮助患者安全地进入病床，以最小的努力重新定位自己，以最小的努力在床边站立，并以最佳稳定的步态离开病床。安全病床的开发将保守地减少10%的床边福尔斯跌倒，从而每年为医疗保健系统节省15亿美元的预防伤害的未来成本。这个拟议的研究项目地址AHRQ的病人安全使命，研究现有的重要医疗保健技术的比较有效性，在这种情况下，医院病床。

DESCRIPTION (provided by applicant): Fall intervention programs in hospitals and nursing homes are performing poorly, and many patients and residents still fall in hospitals and injure themselves. One aspect of the patient's environment that has not been systematically evaluated as a trigger for falls, is the hospital bed. In our pilot research, bed height, instability of the side rails, and the lack of a handhold for use when exiting the bed all contributed to fall risk. In this proposed study we will examine the relationships between bed height, the configuration of side rails, patient's physical characteristics and biomechanical forces that are exerted as the patient climbs in and out of bed. Sixty four participants, recruited from acute and long term care settings, will be videotaped as they interact with a bed that has been instrumented to measure patient strength requirements. Biomechanical, observational, and subjective participant data will be used to determine the optimal hospital bed height and side rail configurations to minimize the risk of falling and reduce the risk of injury. The biomechanical data will include joint torque during bed entry, exiting, and in-bed repositioning, as well as physical interactions between the patient, floor surface and hospital bed. Observed problems such as slips, balance checks, incomplete entry/exit, and near falls will be coded. Participants will provide a subjective assessment of their perception of fall risk associated with different bed heights and side rail configurations. We will also examine the side rail use for in-bed mobility. The ultimate goal of this research program is to develop design recommendations for a hospital bed that will enable the patient to enter the bed safely, to reposition themselves with minimal exertion, to stand with minimal effort at the bedside, and to move away from the bed with an optimally stable gait. This proposed research project addresses AHRQ's Patient Safety Mission to study the comparative effectiveness of important existing health care technologies, in this case the hospital bed. The development of a safe hospital bed will conservatively reduce bedside falls by 10%, thereby saving the healthcare system costs estimated at $1.5 billion per year in the prevention of injury by 2020. PUBLIC HEALTH RELEVANCE: Patient falls from the bed result in serious injuries. In this project we will explore the bed height and stability of the side rails as they contribute to the risk of falling. We will also examine patients' use of the side rail to assist with turning and moving about in the bed. The ultimate goal of this research program is to design a hospital bed that will assist the patient to enter the bed safely, to reposition themselves with minimal exertion, to stand with minimal effort at the bedside, and to move away from the bed with an optimally stable gait. The development of a safe hospital bed will conservatively reduce bedside falls by 10%, thereby saving the healthcare system future costs of $1.5 billion per year in the prevention of injury. This proposed research project addresses AHRQ's Patient Safety Mission to study the comparative effectiveness of important existing health care technologies, in this case the hospital bed.