精神科住院病人跌倒之相關因素探討

Factors Related to Falls Among Psychiatric Inpatients

顏淑華(Shu-Hua Yen)

指導教授 ： 張秀如

臺北醫學大學/護理學院/護理學研究所/碩士(2011年)

摘要

本研究之主要目的為探討北部某區域教學醫院精神科急性病房住院病人跌倒發生事件，並分析影響病人跌倒相關因素。樣本取自97-99年醫院跌倒異常事件報告單，採病歷回溯方法，共收集跌倒組108人，並配對同年份、控制性別、診斷、年齡±10歲等變數，收集非跌倒組共366人，進行統計分析。
研究結果顯示：住院跌倒病人平均年齡45.15歲，診斷以精神分裂症較多，發生班別以白班最多，時間以8-10AM及6-8AM件數最多，發生地點以大廳居多，病人從事活動以行走居多，跌倒原因以病人健康因素最多，跌倒發生率為0.17%，造成傷害率43%。兩組以卡方檢定分析跌倒相關因素，結果發現病人教育程度、6個月內跌倒史、行走能力、排泄問題、使用情緒穩定劑、抗鬱劑、糖尿病用藥與使用精神科用藥種類數目平均4.13種，在二組間具有顯著差異。以t檢定檢視護理人員年資無顯著差異。跌倒造成傷害與跌倒時班別、評估是否為跌倒高危險群病人、跌倒地點、護理人員精神科年資、連續工作天數與當班照顧床數無顯著相關。依邏輯斯迴歸分析在跌倒風險評估：結果顯示整體預測率為77.2%，在24小時所服用的藥物中，有使用情緒穩定劑跌倒風險為沒有使用情緒穩定劑的14.23倍、有使用抗憂鬱劑跌倒風險為沒有使用抗憂鬱劑的1.62倍、每增加服用一種抗精神病藥物種類跌倒風險增加2.01倍。
本研究結果建議將跌倒危險因素：病人教育程度、6個月內跌倒史、行走能力、排泄問題、使用情緒穩定劑、抗鬱劑、糖尿病用藥與使用精神科用藥種類超過 4種，納入精神科住院病人跌倒危險評估工具項目，以有效預防病人跌倒，並針對研究醫院特性，增加各教育程度之預防跌倒衛教內容；且相關預防跌倒教育訓練應涵蓋所有職級之護理人員。
關鍵字：精神科住院病人、跌倒

關鍵字

精神科住院病人 ； 跌倒

並列摘要

The main objectives of this study were to investigate and analyze the relevant factors involved in reports of patient falls in the acute psychiatric ward of a regional teaching hospital in Taoyuan County. Data were obtained from abnormal fall event reports during the year 2008 to 2010. Medical records were studied retrospectively to collect 108 cases for the fall group. 366 cases were collected for the non-fall group and were matched to the fall group with variables such as same year, gender, diagnosis, and age ± 10 years. Statistical analysis was performed on the collected data.

Results showed that the average age of the inpatients was 45.15 years and they were mostly diagnosed with schizophrenia. The events occurred more frequently during day shifts, and the highest incidences occurred were between 8-10 am and 6-8 am in the morning. The location with the most reported events was the hospital’s main hall, and happened frequently during walking. The cause of falls was associated with patient health; the fall incidence rate was 0.17%, and the injury rate was 43%. Chi-square analysis on the two groups revealed significantly differences in factors such as patient’s education level, history of falls within 6 months, walking capacity, excretion capacity, use of mood stabilizers, anti-depressants and diabetes medicines, with an average of 4.13 types of psychiatric drug used. No significant differences were reported with t-test analysis of the seniority of the nursing staff. There were no significant correlations between variables such as injuries due to fall, shift-type during falls, high fall-risk patients, locations of falls, experience of nursing staff in the psychiatric ward, continuous working days and number of beds cared for during shifts. Logistic regression analysis on the risks of falls found that the overall prediction rate was 77.2%; in 24 hours of drug use, the risk of fall after taking mood stabilizers was 14.23 fold higher than without mood stabilizers; the risk of fall after taking anti-depressants was 1.62 fold higher than without anti-depressants; the risk of fall increases 2.01 fold with each additional use of psychiatric drug.

Results from this study suggested including the following risk factors: patient’s education level, history of falls within 6 months, walking capacity, excretion capacity, use of mood stabilizers, anti-depressants, diabetes medicines and whether more than 4 types of psychiatric drug are used, into the lists of falling risk assessment tools of psychiatric inpatients, in order to effectively prevent patients from falling. Hospitals should design health education content on fall prevention fit for all education levels pertaining to the nature of the hospitals; training on fall prevention should include nursing staff of all ranks and pay grades.

Keywords: Psychiatric Inpatients, Falls

並列關鍵字

Psychiatric Inpatients ； Falls

參考文獻

謝昌成、蔡坤維、劉鎮嘉（2007）•老年人的跌倒問題•基層醫學，22（10）， 352-357。

魏大森(2008)•老年人跌倒的篩檢與評估•台灣老年醫學暨老年學雜誌，

張惠琳、樓亞洲、陳立奇(2009)•預防藥物相關之跌倒•北市醫學雜誌，

陳玉枝、林麗華、簡淑芬(2002)•住院病患傷害性跌倒的影響因素與其

理人員護理能力及其相關因素之探討•中山醫學雜誌，18（2），