住院病人跌倒之相關因素探討-以某醫學中心為例

目的本研究以某醫學中心的住院病人為對象，探討跌倒住院病人之基本屬性、環境因素、藥物使用分佈及傷害程度之關係，以提供未來醫院環境安全之改善及建立病人安全感的基礎。方法本研究為回溯性研究，擷取2005-2006年度，某醫學中心住院病患跌倒通報資料庫，共包含數524名個案，研究變項包含1.跌倒病人基本屬性：科別、性別、住院天數、住院跌倒次數、跌倒時間、病患年齡、發生地點、病患健康因素（身體不適、重心不穩）、病患意識狀態及肌力。2.環境方面（地板濕滑、有障礙物、床欄未拉上）。3.藥物（精神鎮靜、心臟用藥）4. 造成身體傷害嚴重級數。以描述性統計了解研究個案之基本特性，並以卡方檢定、獨立樣本T檢定、對數迴歸分析、Amos統計方法進一步了解病人跌倒之相關因素。結果跌倒通報個案524例中，在個案基本屬性方面：年齡、科別、跌倒地點、意識狀態、肌力、重心不穩及身體不適與傷害嚴重度均有達顯著正相關。環境因素方面：地板濕滑與傷害嚴重度（p＝0.02）有達顯著正相關。藥物使用方面：服用精神鎮靜用藥與傷害嚴重度（p＝0.03）達顯著相關。另經對數迴歸分析中發現重心不穩而跌倒之病患會發生嚴重傷害是無重心不穩病患的1.68倍（p＝0.032），因身體不適之病患跌倒會發生嚴重傷害是無身體不適病患的2.41倍（p＝0.03）。另地板濕滑而跌倒之病患會發生嚴重傷害是無地板濕滑病患的2.45倍（p＝0.025）。若服用精神鎮靜安眠藥物之病患而跌倒會發生嚴重傷害是無服用精神鎮靜安眠用藥之病患的1.75倍（p＝0.044）。同時因地板濕滑和重心不穩病患跌倒會發生嚴重傷害是無地板濕滑和重心不穩病患的7.283倍（p＝0.01）。同時因重心不穩和精神鎮靜安眠用藥病患跌倒會發生嚴重傷害是無重心不穩和精神鎮靜安眠用藥病患的6.89倍（p＝0.005）。同時因地板濕滑、精神鎮靜安眠用藥和重心不穩病患跌倒會發生嚴重傷害是無地板濕滑、精神用藥和重心不穩病患的29.19倍（p＝0.01）。結論與建議本研究結論為：1.住院病人之基本屬性（年齡、科別、地點、意識狀態、肌力、重心不穩、身體不適），確實會影響病人跌倒傷害嚴重度。2.環境因素（地板溼滑）及藥物使用（精神鎮靜藥）與跌倒傷害嚴重度有顯著相關。3.跌倒住院病人之基本屬性、環境因素及藥物使用與傷害嚴重度有顯著交互作用。4.跌倒住院病人年齡、意識狀態、住院天數及肌力預測病人傷害程度是有顯著的路徑關係。根據結論提出建議：1.醫院管理者需提供環境改善及藥物使用安全性。2.研究結果所確定造成跌倒傷害相關因子（如年齡、意識狀態等），作為護理人員評估的證據指引。3.針對跌倒高危險群的病患，注意其生理變化並進行衛教宣導。4.病室及廁所應隨時保持乾燥地板。5.衛教病人及家屬使用藥物產生副作用會導致跌倒之注意事項。期望本研究能提供病患一個安全無慮的治療環境，及早確認高度危險傾向的病患及環境，提供安全治療環境，預防病人意外跌倒發生，提升病患照護安全。

關鍵字

住院病人；跌倒；傷害嚴重度；安全

並列摘要

Objective This study took the inpatients of one medical center as its subjects and discussed the attributes, environmental factors, medication and the trauma severity of the patients who fell over during their stay in the center. Hopefully, the results will establish the foundations of environmental safety and patients’ sense of safety for hospitals in the future. Methods This study was a retrospective review of the reported cases database of the year 2005~2006, describing the 524 patients who fell. The outcome variables included the following factors: 1. The attributes of the patients, including department, gender, length of hospital stay, number of falls during their stay in hospital, times of falls, age, locations of falls, the health condition of the patients (sickness or losing their balance), consciousness and muscular strength. 2. Environmental factors such as wet floors, barriers and failing to raise the bed fence. 3. Drugs use(tranquilizers, medicine for heart disease) 4. The severity of the injury The study analyzed the basic attributes of every case using descriptive statistics, and gained further understanding of the reasons for falls through Chi-square tests, Independent-Sample T tests, Logarithmic Regression Analysis and Amos. Results In the 524 reported cases of falls,, the patients’ basic attributes including age, department, location of fall, consciousness, muscular strength, sickness and losing balance were all significantly positively related to the injury severity. As for the environmental factors, the floor being wet was significantly positively related to the severity of the injury (p=0.02.) The use of drugs such as tranquilizers and medicine for heart disease were also shown to be positively related to the injury severity (p= 0.03.) Additionally, the Logarithmic Regression Analysis indicated that patients who fell due to losing their balance had 1.68 times the chance of suffering serious injury than those who fell for other reasons (p= 0.032.) The patients who fell due to sickness had 2.41 times the chance of suffering serious injury as the patients who fell for other reasons (p=0.03.) The number of patients who fell due to the floor being wet and who were seriously injured were 2.45 times the number of patients who didn’t (p=0.025.) Taking tranquilizers or sleeping pills resulted in 1.75 times the chance of serious injury of the patient (p=0.044.) The ratio of patients who fell because of the floor being wet and losing their balance at the same time, and those who fell for either reason was 7.283:1 (p=0.01,) and the comparison of patients who fell because of both losing their balance and taking tranquilizers, and those who didn’t, resulted in the ratio of 6.89:1 (p=0.005.) Finally, the patients who fell because of a combination of the floor being wet, taking tranquilizers and losing their balance had 29.19 times the chance of suffering a serious injury than the patients who fell for other reasons (p=0.01.) Conclusion and Suggestions The conclusion can be summarised as the followings: 1. The patients’ basic attributes, including age, department, location of falling, consciousness, muscular strength, sickness and losing balance all had an influence on the severity of the patient’s injury. 2. Environmental factors (wet floor) and medication (tranquilizer) were significantly related to the injury severity. 3. There were significant interactions between the inpatients’ attributes, environmental factors, medication and the severity of the patients’ injuries. 4. The age, consciousness, length of hospital stay, muscular strength and the prediction of the patient’s injury severity formed a significantly certain path. The suggestions are as the followings: 1. The administrator of the hospital should improve the environment, and the safety of the medication. 2. The factors which were proved by the study to be significant in causing falls such as age, consciousness, etc. should be regarded as an index for the nursing staff to evaluate the patients’ condition. 3. More attention must be paid to the physical condition of the patients in the “high risk” group and more education programs need to be implemented. 4. The floors of wards and bathrooms must always be kept dry. 5. The patients and their families must have enough knowledge about the side effects of the medicine they are taking. We expect this study can help to provide the patients with a carefree environment of remedy and care, identify in advance the patients most in danger of falling and the most dangerous environmental conditions, prevent the patients from falling, and raise the safety of patient care.