Fall prevention in high-and low-fall hospital nursing units

项目摘要 有无数的策略声称可以减少住院福尔斯，但几乎没有证据 支持他们的使用，最近的一项定量审查发现，没有证据表明， 发表了使用同期对照的医院跌倒预防研究。鉴于重大财务 压力下，医院正在寻求预防跌倒的“银弹”， 利用昂贵的、未经证实的和劳动密集型的方法来预防跌倒。巧合的是， 这些做法可能会增加病人护理的认知负担，并增加病人的风险。 了解和最大限度地减少变异是提高医疗保健质量的有用工具，但 不适用于医院福尔斯。在这项拟议的研究中，我们将继续我们的5年 与国家护理质量指标数据库（NDNQI）合作，一项研究和 一个质量改进小组，培训其约2000家参与的美国医院收集和报告 以标准化格式提供对护士敏感的质量指标和人员配置数据。在我们的预备 工作，我们确定了NDNQI成人医疗护理单位与24个月高-（~7福尔斯/1000 患者-天）和低跌倒率（约2次福尔斯/1000患者-天）。该研究计划将扩大 NDNQI数据收集专门关注患者和组织级别的跌倒预防 高绩效和低绩效单位的策略。 目的1：比较高和低血压患者预防跌倒的方法。 秋季单位。我们将扩展NDNQI患者级数据收集，以确定：（1）器械，以及（2） 警惕和（3）环境改造战略，并比较其使用，调整 患者级别的风险。 目的2：探索不同的组织层面的方法，以防止跌倒 高低落差的单位。我们将扩展NDNQI组织级数据收集， 比较：（1）防坠落资源，（2）劳动力质量和数量，以及（3）坠落安全文化 在高低落差之间

PROJECT SUMMARY There are a myriad of strategies claimed to reduce hospital falls, but there is little evidence supporting their use, and a recent quantitative review found no evidence of benefit among published hospital fall prevention studies using concurrent controls. Given significant financial pressure, hospitals are seeking a “silver bullet” to fall prevention, and are all over the board in utilizing costly, unproven, and labor-intensive approaches to fall prevention. Paradoxically, these practices may add to the cognitive burden of patient care and increase patient risk. Understanding and minimizing variation is a useful tool for improving health care quality, but has not been applied to hospital falls. In this proposed study we will continue our 5 year collaboration with the National Database of Nursing Quality Indicators (NDNQI), a research and quality improvement group that trains its ~2000 participating U.S. hospitals to collect and report nurse-sensitive quality indicators and staffing data in a standardized format. In our preparatory work, we identified NDNQI adult medical nursing units with 24 month high- (~7 falls /1000 patient-days) and low- (~2 falls/1000 patient-days) fall rates. The proposed research will extend NDNQI data collection to focus specifically on patient- and organization-level fall prevention strategies on high- and low- performing units. Aim 1: Compare patient-level approaches to fall prevention employed in high- and low- fall units. We will extend NDNQI patient-level data collection to ascertain: (1) device, and (2) vigilance and (3) environmental modification strategies and compare their use, adjusting for patient-level risk, on these units. Aim 2: Explore differences in organization-level approaches to fall prevention employed in high- and low-fall units. We will extend NDNQI organization-level data collection to compare: (1) fall prevention resources, (2) labor quality and quantity, and (3) fall safety culture between high- and low fall units.