某地區教學醫院住院病人跌倒受傷模式及預測因子之研究

中文摘要近年來以病人為中心及重視病人安全的醫療照護理念，是全球醫療品質推動的主流。跌倒除了造成身體的傷害外，伴隨的是住院天數及醫療費用支出的增加，也造成病人、病患家庭及社會的負擔，對患者及其家屬所造成的心理與社會的影響更是難以估計；因此如何讓病人避免傷害性跌倒，以及減少跌倒後的失能及死亡，是醫療照護重要的課題。本研究針對中部某地區教學醫院101年4月1日至105年12月31日病人安全通報系統中之「跌倒通報事件」，進行住院病人傷害性跌倒之相關因素分析。旨在探討住院病人跌倒事件之現況、研究病人發生跌倒的相關因素，以及傷害性跌倒的高危險因子，採用回溯性資料收集方法，以描述性統計、卡方檢定及羅吉斯迴歸分析法進行統計分析。研究結果顯示跌倒病人年齡分布以16-64歲最多，以男性、內科居多，跌倒當時以有家屬陪伴者最多，小夜班發生人數較多，能自行下床病人屬跌倒高危險群，跌倒發生地點多為病床邊，跌倒當時以無約束、意識清醒者多，跌倒原因多為和病人健康因素有關，無傷害者多於有傷害者。所有個人背景變項及跌倒相關變項在跌倒傷害程度的卡方檢定皆未達顯著水準(p>.05)，利用二元羅吉斯迴歸分析，清醒的跌倒個案，會受到中重度傷害的風險較低(p<.01)；有受到約束的個案、意識清醒的個案以及在交誼廳的個案，受到中重度傷害的風險較低(p<.05)。研究結果可提供臨床人員參考，針對傷害性跌倒高危險因子採取適當防範措施，以減少跌倒事件發生及降低跌倒的傷害程度，提升病人住院安全及醫療照護品質。

關鍵字

住院病人；傷害性跌倒；病人安全；醫療品質

並列摘要

Abstract In recent years, the medical concept of patient-centered and attention of the patient safety care is the mainstream of global medical quality improvement. Falling not only cause physical harm, accompanied by the increase of the number of days in hospital and medical expenses, but also caused the burden to the patient, the patient family and the society. Its psychological and social impact on patients and their families is also difficult to estimate; Therefore, how to make patients to avoid nociceptive falling, and to reduce the disability and death after falling, is an important subject of medical care. This study analyze for the relevant factors in the case of inpatients' nociceptive falling notifications circulate by the patient safety notification system from April 1, 2012 to December 31, 2016, in a teaching hospital in the central Taiwan. The aim of this study is to investigate the current status of falling in the inpatients, to study the factors associated with the fall of the patients, and the high-risk factors of nociceptive fall. Used the retrospective data collection method, the descriptive statistics, chi-square test and logistic regression analysis. The results showed that the age distribution of the patients was 16-64 years old, with the largest number of males and internal medicine. The victims are often with their family while it happens. Often during night swift while it happens, and the patients who were able to get out of bed are the high-risk groups. It mostly happens at the bedside. Most victims are unconstrained and conscious while it happens. The reasons mostly related to patient's health problems. The number of the victims who have hurt is lower than which have not. All personal background variables and fall-related variables did not reach significant levels in the chi-square test (p> .05) .Using binary logistic regression analysis, a falling case with a conscious victim would be at a lower risk of moderate to severe injury (p <.01),the cases with a constrained victim, with a conscious victim or happened in the saloon, would be at a lower risk of moderate to severe injury (p <.05). The results of this study can provide to clinical personnel, to appropriate precautions against the high-risk factors of nociceptive falling, to reduce the incidence and the degree of injury of falling, to improve the patient hospitalization and medical care quality.