Trial of Proximity Alarms to Reduce Patient Falls

描述(由申请人提供)：近距离警报系统被推广为一种减少跌倒和减少医院使用物理约束的方法，但它们没有经过严格的测试。这项拟议研究的目标是测试一种干预措施，在田纳西州孟菲斯的卫理公会大学医院(M-UH)引入并实施针对住院患者跌倒风险的近距离警报。M-UH是一家拥有652张床位的城市社区医院。该医院为不同的成人患者群体提供初级到三级护理。 我们建议在密歇根大学16个设有25张病床的普通内外科护理病房中进行一组随机试验来测试干预措施。护理单元将根据最初3个月观察期内发生的跌倒发生率随机分成2组。在为期15个月的干预中，8个护理单元将随机接受基于警报的干预，8个护理单元将利用现有的护理方法将跌倒降至最低。干预单元将获得足够的接近警报监测系统，适用于护理人员认为有高跌倒风险的所有患者。由一名护士冠军、老年医生和生物医学仪器专家组成的实施小组将对干预单位进行培训和定期跟踪，以解决与使用警报器有关的技术问题。护士经理将使用我们开发的收集患者(例如，姿势和体位血压)和以标准化方式收集的环境数据的方法，前瞻性地确定主要结果衡量标准：患者跌倒。 这项研究的主要目的是确定近距离警报监测是否可以减少跌倒。我们设计这项研究是为了检验这样一种假设，即患者在接受干预治疗时跌倒的几率比对照组低25%。第二个目标是确定邻近警报监测是否减少了物理约束的使用，或降低了患者护理成本。 这将是第一个评估这种有希望减少医院跌倒的方法的方法的可靠研究。无论警报器是否成功地减少跌倒，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预防跌倒相关的临床实践。

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.