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

医院和疗养院的秋季干预计划表现不佳，许多患者和 居民们仍然在医院摔倒并受伤。患者环境的一个方面没有 被系统评估为跌倒触发因素的是医院的病床。在我们的初步研究中，床高， 侧栏不稳定，以及下床时没有扶手可用，这些都导致了跌倒的风险。 在这项拟议的研究中，我们将研究床高、侧栏配置、 病人在爬进爬出时的身体特征和生物力学作用力 在床上。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 与已安装仪器以测量患者力量要求的床进行交互。生物力学， 观察性和主观性参与者数据将用于确定最佳医院床位高度和 侧轨配置可将坠落风险降至最低，并降低受伤风险。生物力学数据 将包括进床、出床和床上重新定位时的关节扭矩，以及物理相互作用 在病人、地面和病床之间。观察到的问题，如滑倒、平衡检查、 不完整的入口/出口，以及附近的瀑布将被编码。参与者将提供对他们的 感知与不同床位高度和侧栏配置相关的跌倒风险。我们还将检查 侧轨用于床上活动。这个研究项目的最终目标是开发设计 推荐一张医院病床，使患者能够安全地进入病床，并重新定位 以最小的力气站在床边，并离开 拥有最佳稳定步态的床。这项拟议的研究项目解决了AHRQ的患者安全使命 为了研究现有重要医疗保健技术的比较有效性，在这种情况下， 医院病床。开发一张安全的医院床位将保守地将床边跌倒减少10%， 从而在预防伤害方面节省医疗系统成本，估计每年为15亿美元 2020年。

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.