以系統性回顧探討台灣地區住院病人跌倒危險相關因素

跌倒是住院病人安全中一個重要指標，跌倒可造成身體的傷害，嚴重者可能因此喪失自理功能。除了造成個人傷害、增加家庭負擔、社會成本，也容易引起醫療糾紛。研究目的旨在探討台灣地區住院病患跌倒的危險相關因素，運用系統性回顧，以設定關鍵字進行文獻搜尋，搜尋EBSCO(包含Academic search complete, Medline, CINAHL Plus, ERIC), Proquest, PubMed , 華藝線上圖書館、台灣期刊論文及政府研究資訊醫療照護系統等資料庫。相關文獻收集包括已發表的國內外期刊原創性量性研究共30篇，含2篇世代研究、13篇病例對照研究、15篇橫斷式研究，研究發表於2016年6月30日前之原創性研究，由兩位審查者分別進行審查，研究品質以Joanna Briggs Institute(JBI) Standardised Critical Appraisal Tool做評讀。研究結果顯示1.人口社會學:男性、大於65歲、無跌倒病史、日常活動或工具性日常活動障礙、無陪伴者為跌倒高危險群2.地點:以病床邊或病人單位居多、其次為浴室廁所、走廊次之3.時間:發生於大夜班00:00-08:00最多、其次為白班08:00-16:00;住院一周內為最容易發生跌倒的日數4.情境:常發生於上下床時、走路時、如廁或準備如廁時5.科別:多發生於精神科、內科、外科6.跌倒所造成的結果:以無造成傷害佔15.6-84%、一級傷害佔9.3-78%，為最常發生的傷害7.健康因素中的疾病因素為:憂鬱症、思覺失調症、心臟病、高血壓、中風；影響跌倒的生理因素為: 全身虛弱、行動障礙、平衡不良、頭暈、意識/情感障礙、激躁不安、排泄問題、睡眠不穩8.環境因素為:地板濕滑、未使用床欄、床太高9.跌倒患者使用藥物因素為:抗精神病、鎮靜安眠藥、抗憂鬱劑、情緒穩定劑、輕瀉軟便藥、降血壓、抗焦慮、利尿劑。此結果可提供醫療單位預防跌倒防範的參考，有助於護理人員提高辨識高危險跌倒病人，並檢查病人用藥安全及評估生理狀況，加強提醒病人的危機意識和環境安全的認知及指導日常活動的安全防護，促進防範病人跌倒之參考依據及方向。

關鍵字

跌倒；危險相關因子；住院病人；系統性回顧；評讀工具

並列摘要

Fall is an important patient safety issue. It can cause physical harm, and in severe cases, people may lose their self-care function. In addition to causing personal injury, it can increase the burden on the family, social costs, and lead to medical disputes. The purpose of this study was to systematically review the risk factors related to falling among inpatients in Taiwan. The literature search included EBSCO (inculding Academic search complete, Medline, CINAHL Plus, ERIC), Proquest, PubMed, CEPS, National Digital Library of Theses and Disserations in Taiwan, and Government Research Bulletin (GRB) medical databases with keywords. The collection of relevant literature included 30 original quantitative research studies published in domestic and English journals. The collection included 2 cohort studies, 13 case-control studies, and 15 cross-sectional studies. Original research published before June 30, 2016 were individually reviewed by 2 reviewers. The quality of the studies was assessed using critical appraisal tools from the Joanna Briggs Institute (JBI). The results showed that fall and physical injury rates ranged from 0.02-21% and 22-86.1% respectively. The risk factors related for falling included: (1) Demographic factors: male, aged over 65 years, having fall history, dysfunction in ADL or IADL, without companions were at high risk of falling; (2) Location factors: bedside and bed unit, bathroom with toilet, and in the hall way; (3) Timing factors: Most frequently, falls occurred during the night between 00:00-08:00, followed by occurrences during the day between 08:00-16:00. In addition, patients were most likely to experience falls within the first week of hospitalization;(4) Situation factors: getting in or out of bed, walking to bathroom, walking; (5) Department factors: Falls were most frequently observed in psychiatry departments, internal medicine wards, and surgery wards;(6) Results from falls: 15.6-84% of the falls did not result in physical injuries, 9.3-78% led to first-degree injuries, and was the most common type of injury caused by falls; (7) Medical factors related to falls included depressive disorder, schizophrenia, heart disease, hypertension, and stroke; Physiological factors related to falls included general weakness, mobility dysfunction, imbalance, dizziness, confusion/ disorientation, agitation, elimination problem, and sleep disorders; (8) Environmental factors: walking on slippery floor, not use bedrails, bed too high; and (9) Medication-use factors for fall include antipsychotic, sedative/ hypnotic, antidepressant, mood stabilizer, laxative, anti-hypertension, antianxiety, diuretic. These results can serve as a reference for the prevention of falls in medical units. This will help clinical nurses provide high risk patients measures based on their characteristics to reduce the incidence and physical injury rates of falls, thereby improving patient safety. Reminders for danger awareness and cognition of environmental safety should be enhanced in nurses and patients, which would effectively prevent the occurrence of falls.