使用離床報知機偵測離床降低住院病人跌倒之研究

The Effects of the Bed-Exit Alarm System on Fall Prevention in a Medical Center

林小玲(Shir-Ling Lin) ； 謝雅宜(Ya-I Hsieh) ； 溫明寰(Ming-Huan Wen)

《榮總護理》 33卷2期 (2016/06) Pp. 164-175

https://doi.org/10.6142/VGHN.33.2.164

摘要

離床報知機對預防住院病人跌倒之成效不一，本研究目的為評估離床報知機是否可有效偵測病人離床，及是否減少住院老人跌倒異常事件的發生。本研究為兩組前瞻式追蹤觀察型設計，計算離床報知機偵測病人離床之敏感性及特異性，與比較離床報知機使用前後各半年跌倒發生率之差異。第一部份共收集175 位符合適應症、使用離床報知機病人之機器警示資料，由護理人員每日工作中以記錄表收集資料，在台北某醫學中心4個病房收案。第二部份則先收集未正確使用離床報知機時病人是否跌倒之資料，再收集正確使用離床報知機時病人是否跌倒之資料。資料分析：離床報知機準確度採用Diagnostic test分析；病人屬性與是否跌倒，使用X^2 test與相關危險度檢定。主要結果：一、離床報知機之敏感性為94.4%、特異性為73.5%，陽性預測值為68.9%，陰性預測值為95.4%，而相似比為3.56；二、未依照離床報知機作業標準，跌倒發生率0.166%；依照離床報知機制訂標準作業流程執行，跌倒發生率0.126%；三、離床報知機適用族群稽核監測遵從率為81.4%，正確性監測為97.3%；四、使用離床報知機能降低17.2%跌倒發生風險。本研究搜尋國內外研究相關文獻，製作離床報知機標準作業規範，藉由修訂住院病人預防跌倒執行對策、並善用離床報知機，期望降低住院老人跌倒發生率、跌倒傷害率，降低醫療成本，確保病人獲得完善的照護。

關鍵字

離床報知機 ； 跌倒 ； 住院病人 ； 診斷型分析

並列摘要

Most falls in acute care settings occur in the rooms of patients, especially during attempts to get in or out of bed. Bed-exit alarms were designed to detect patients moving out of their beds, thereby increasing staff surveillance of cognitively and/or physically impaired patients at risk for bed-related falls. However, the overall reliability of bed-exit alarms in detecting patient movements out of bed has not been clearly established. The purpose of this study is to develop an evidencebased bed-exit alarm care guideline for patients in acute care settings and to provide comprehensive strategic care plans for fall prevention among these patients. This research was conducted through a two-group, 6-month cohort perspective study to investigate the effectiveness of bed-exit alarms in preventing falls among patients in acute care settings. The relative ratio of falls, injury-related falls and fall rates in the two groups were computed and analyzed. The accuracy of the bed-exit alarms was calculated. The main findings were as follows: (1) the sensitivity, specificity, and likelihood ratio of the bed-exit alarm were 94.4%, 73.5%, and 3.56, respectively, for detecting when high fallrisk patients exited their beds; (2) the fall rate of the regularly performed bed-exit alarm cohort group was 0.126% and the fall rate of the nonregularly performed bed-exit alarm cohort group was 0.166%; (3) the adherence rate of nurses for performing the evidence-based bed-exit alarms care guideline was 81.4%; (4) the absolute risk reduction from using the bed-exit alarm was 17.2%. The result of this study is to develop a bed-exit alarm care guideline for patients and to implement an intervention to judge appropriateness in applying a bed-exit alarm system. Furthermore, it is recommended to expand this bed-exit alarm care guideline to other institutions.

並列關鍵字

bed-exit alarm ； fall ； acute care setting ； diagnostic test

參考文獻

林小玲、溫明寰、陳玉枝(2010)．跌倒危險評估量表準確度之研究．醫護科技學刊，12(1)，47-59。

康家豪、王文揚、李政翰、施維哲(2007)．應用資通技術於長期照護之危險偵測．長期照護雜誌，11 (4)，370-380。

羅元婷、羅慶徽、朱明若、許佩榮、張俊喜、林金定(2007)．跌倒防治策略之探討．台灣老人保健學刊，3(1)，14-29。

Anderson, O., Boshier, P. R. & Hanna, G. B. (2012). Interventions designed to prevent healthcare bed-related injuries in patients. Cochrane Database of Systematic Reviews, Issue 1. Art. No: CD008391.

Cameron, I. D., Murray, G. R., Gillespie, L. D., Robertson, M. C., Hill, K. D., Cumming, R. G., & Kerse, N. (2010). Interventions for preventing falls in older people in nursing care facilities and hospitals. Cochrane Database of Systematic Reviews, Issue 1. Art. No: CD005465.