住院病人跌倒相關因素之探討

Related factors of falls in hospitalized patients

陳杏娥(Hsing-E Chen)

指導教授 ： 許玫琪

義守大學/醫學院/醫務管理學系/碩士(2018年)

摘要

美國每年有將近70萬到100萬人次在醫院發生跌倒。在過去10年，美國醫療機構評審聯合委員會就已將「減少病人因跌倒造成傷害的風險」列為病人安全目標之一。自2008年迄今，每年跌倒通報件數都高居病安事件第二名。從2014年至2016年，跌倒通報案件每年平均約12,674件，跌倒傷害件數佔約51.7%，顯見預防跌倒是病人安全的重要議題。
研究旨在探討影響住院病人跌倒的相關因素，採用病例對照研究，研究地點是在高雄市某一間區域教學醫院執行，收案時間為2016年1月至12月。對照組配對條件是依據與病例組科別、年齡、同病房、最接近之住院日期，住院期間無跌倒行為之病人。研究資料以SPSS 22.0統計軟體進行資料分析，統計方法運用描述性統計分析和推論性統計，包括單變項分析，連續變項採T檢定，類別變項採卡方檢定，多變項分析包含簡單邏輯斯迴歸分析及多邏輯斯迴歸分析。
本研究共收案438人，其中個案數病例組和對照組各219人。發現造成跌倒顯著相關因素為:住院天數每增加一天病人跌倒的勝算比1.10(95% CI, 1.05-1.143)；最近一年有跌倒的經驗(OR, 7.07；95% CI, 1.761-28.376)；高危險跌倒群者(OR,78.78；95% CI, 22.949-270.405)；跌倒發生前需要協助活動者(OR, 22.59；95% CI, 7.429-68.691)；平日無陪伴者(OR, 0.19；95% CI, 0.084-0.418)；步態不穩者(OR, 3.88；95%CI, 1.262-11.932)；步態不穩、肢體行動障礙及眩暈感者(OR, 14.13；95% CI, 3.184-62.732)。另外評估日常生活活動中移位能力受限時，須立即給予移位技巧指導；以及應用共病分數衡量病人合併症，進一步評估潛藏引發跌倒危險因子。
本研究結果期能做為臨床跌倒評估檢核的參考，針對評估選出有高風險跌倒之病人，給予個人化之跌倒預防措施，以降低跌倒發生率，減少傷害。

關鍵字

跌倒 ； 住院病人 ； 相關因素 ； 病例對照研究

並列摘要

In the United States, approximately 700,000 to 1 million people fall in hospitals every year. In the past 10 years, the Joint Commission on Accreditation of Healthcare Organization (JACHO) has listed the "Reducing the risk of patient's injury caused by fall" as a patient safety goal. Since 2008, the number of reported fall incidences ranked second in the annual incident. During 2014 to 2016, the average number of cases of falls reported was 12,674 per year, and 51.7% of injuries were caused by falls. Therefore, preventing patient falls and injuries is an important issue in patient safety.
The purpose of this study was to identify causes and risk factors of falls in in-patients. A case-control study was carried out in a regional teaching hospital in Kaohsiung city from January to December, 2016. The pairing condition was based one patient's department, age, same ward, the matched admission date, and with or without fall history during hospitalization. The data of this study was analyzed using SPSS 22.0 package. The statistics in this study used both descriptive and inferential statistics including single variable analysis, categorical variables adopt chi-square test, T test in continuous variables, and multivariable analysis (such as simple logistic regression and multivariate logistic regression).
In this study, 438 patients were recruited. Among them, 219 were in the case group and 219 in the control group. The multiple logistic regression analysis has identified several risk factors of falls in inpatients as follows: every additional day patient stays in hospital, the odds ratio (OR) of fall increased by 1.10 (95% confidence interval [95% CI] 1.05-1.143); fall experience in the previous year (OR, 7.07；95% CI, 1.761-28.376); patients with a high risk of falling (OR,78.78；95% CI, 22.949-270.405); patients with the needs of assistance before falling (OR = 22.59, 95% CI 7.429-68.691), and for patients with no companion (OR = 0.19, 95% CI 0.084-0.418), patients with an unstable gait (OR = 3.88, 95%CI 1.262-11.932), and patients with an unstable gait, limb dysfunction, and dizziness (OR = 14.13, 95% CI 3.184-62.732). In addition, when patients’ limited shift capability is found in daily life activities, it is necessary to provide guidance on shifting skills. The Charlson Comorbidity Index (CCI) should also be applied to assess comorbidity levels in clinical practices.
The results of this study can be useful as a reference for the clinical falls assessment. Effective screening patients with high-risk of falls and giving individualized fall prevention measures can reduce the incidence of falls and reduce fall-related injuries.

並列關鍵字

fall ； hospitalized patients ； related factors ； case-control study

參考文獻

Charlson, M. E., Pompei, P., Ales, K. L., & MacKenzie, C. R. (1987). A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis, 40(5), 373-383.

Tinetti, M. E., & Speechley, M. (1989). Prevention of falls among the elderly. N Engl J Med, 320(16), 1055-1059. doi:10.1056/nejm198904203201606

中文文獻

李玉如 (2013)·老人住院期間跌倒經驗之探討 (未發表碩士論文)·台中市:中臺科技大學。[Li, Y. J. (2014). The experiences of fall in elderly during hospitalization (Unpublished master’s thesis).Central Taiwan University of Science and Technology Department of Nursing. Taichung City, Taiwan, ROC.]

李玉蘭 (2010)·南部某區域醫院住院病人跌倒相關危險因素研究(未發表碩士論文)· 高雄市:輔英科技大學。[Lee, Y. L. (2010). Study on Risk Factors of Fall in a Regional Hospital in Southern Taiwan (Unpublished master’s thesis). Fooyin University, Kaohsiung City, Taiwan, ROC.]