簡化住院病人跌倒風險篩檢表

跌倒是世界各國重大的健康照護議題，也是某醫學中心異常事件的首位，佔所有病人安全通報事件的四分之一，跌倒後有將近一半的病人發生輕度到中重度不等的傷害。醫院原版16項跌倒風險篩檢表過於繁瑣，評估時間耗時，且敏感性、特異性效益不佳。本研究旨在簡化南台灣某醫學中心病人跌倒風險之篩檢表。本研究採回溯性病例對照方式，於南部某醫學中心進行資料收集。以醫學中心原有16項跌倒危險評估內容收集資料，收集2015年全年住院當中跌倒通報之病人169人，平均年齡63.9歲，對照組採科別分層隨機抽樣，控制年齡及科別變項，人數1：1方式，收集住院當中沒有跌倒的病人169人，總共完成338人資料收集。以SPSS 20.0統計軟體，進行兩組描述性統計、卡方檢定及診斷性試驗進行資料分析。結果呈現338位項案中男性211人，女性127人，年齡大多分佈在52.0~80.3歲之間，卡方檢定分析出7項跌倒危險因素，分別為步態不穩、過去一年曾跌倒、頭暈/眩、不認為自己會跌倒、下床需人協助、使用鎮靜安眠藥及輕瀉劑，做為簡版跌倒風險篩檢表之項目。ROC曲線求得最佳AUC.725，以一項一分，≧2分收案的敏感度83.4%、特異性43.8%、陽性預測值59.7%、陰性預測值72.5%及Youden index .40最好。本研究之簡版跌倒風險篩檢表經修訂後應用在臨床護理，做為護理師入院評估及每日身體評估中篩選跌倒高風險病人之依據，以適時訂定預防跌倒之護理計畫與措施。

關鍵字

住院病人；跌倒；危險因素；工具

並列摘要

Falling, a major health care issue in countries across the world is also the first one accident occurring most frequently in our hospital, accounting for more one quarter of all cases reports on patient safety incidents. Almost half of the patients fall that exhibited minor, moderate or severe injuries. An original 16 items fall risk screening tool was complicated and wasted time that the outcomes of sensitivity and specificity benefit was ineffective. The purpose of this study was to simplify a risk screening tool that applicable to predict the patient fall in a medical center in southern Taiwan. We used a 16 items screening tool and conducted a retrospective case-control study based on data collected between January 2016 and February 2016 regarding 169 cases of inpatient falls reported in a medical center in 2015. A control group was selected from stratified random sampling of patients treated at various departments. By controlling age and conducting a 1:1 matched sampling, we recruited inpatients that did not fall during hospitalization, totally obtaining 338 cases of data. SPSS Version 20.0 was employed to analyze the descriptive statistics of the two groups and conduct chi-square tests and diagnostic test. The 338 inpatients including male 211, female 127, and ages mostly from 52.0 to 80.3 were gathered for analysis. The results of a chi-square analysis indicated the following seven risk factors of falling: unsteady gait, past history of falls, dizziness/vertigo, patient overestimates ability/forgets limitation, needing assistance in ambulation, sedative hypnotics medication and laxative medication. The simple version of fall risk screening tool including 7 items is appropriate, the data were analyzed by receiver operating characteristic curve (ROC), the result of the analysis showed an AUC = .725. The sensitivity, specificity, positive predictive value and negative predictive value were 83.4%, 43.8%, 59.7% , 72.5% and Youden index .40, respectively, for detecting high risk of patients falling, based on the fall risk screening score using 2 points as a cutoff value. The falls risk screening tool could be used by clinical nurses as a procedure in daily physical assessments or patient admissions to identify patients with a high risk of falling. On the basis of the results of the screening, nurses can immediately formulate nursing plans and interventions that prevent patient falling.