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Abstract：
BACKGROUND: Hospital falls continue to be a persistent global issue with serious harmful consequences for patients and health services. Many clinical practice guidelines now exist for hospital falls, and there is a need to appraise recommendations.
METHODS: A systematic review and critical appraisal of the global literature was conducted, compliant with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Web of Science, Embase, CINAHL, MEDLINE, Epistemonikos, Infobase of Clinical Practice Guidelines, Cochrane CENTRAL and PEDro databases were searched from 1 January 1993 to 1 February 2024. The quality of guidelines was assessed by two independent reviewers using Appraisal of Guidelines for Research and Evaluation Global Rating Scale and Appraisal of Guidelines of Research and Evaluation Recommendation Excellence (AGREE-REX). Certainty of findings was rated using Grading of Recommendations Assessment, Development and Evaluation Confidence in Evidence from Reviews of Qualitative Research. Data were analysed using thematic synthesis.
RESULTS: 2404 records were screened, 77 assessed for eligibility, and 20 hospital falls guidelines were included. Ten had high AGREE-REX quality scores. Key analytic themes were as follows: (i) there was mixed support for falls risk screening at hospital admission, but scored screening tools were no longer recommended; (ii) comprehensive falls assessment was recommended for older or frail patients; (iii) single and multifactorial falls interventions were consistently recommended; (iv) a large gap existed in patient engagement in guideline development and implementation; (v) barriers to implementation included ambiguities in how staff and patient falls education should be conducted, how delirium and dementia are managed to prevent falls, and documentation of hospital falls.
CONCLUSIONS: Evidence-based hospital falls guidelines are now available, yet systematic implementation across the hospital sector is more limited. There is a need to ensure an integrated and consistent approach to evidence-based falls prevention for a diverse range of hospital patients.
METHODS: A systematic review and critical appraisal of the global literature was conducted, compliant with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Web of Science, Embase, CINAHL, MEDLINE, Epistemonikos, Infobase of Clinical Practice Guidelines, Cochrane CENTRAL and PEDro databases were searched from 1 January 1993 to 1 February 2024. The quality of guidelines was assessed by two independent reviewers using Appraisal of Guidelines for Research and Evaluation Global Rating Scale and Appraisal of Guidelines of Research and Evaluation Recommendation Excellence (AGREE-REX). Certainty of findings was rated using Grading of Recommendations Assessment, Development and Evaluation Confidence in Evidence from Reviews of Qualitative Research. Data were analysed using thematic synthesis.
RESULTS: 2404 records were screened, 77 assessed for eligibility, and 20 hospital falls guidelines were included. Ten had high AGREE-REX quality scores. Key analytic themes were as follows: (i) there was mixed support for falls risk screening at hospital admission, but scored screening tools were no longer recommended; (ii) comprehensive falls assessment was recommended for older or frail patients; (iii) single and multifactorial falls interventions were consistently recommended; (iv) a large gap existed in patient engagement in guideline development and implementation; (v) barriers to implementation included ambiguities in how staff and patient falls education should be conducted, how delirium and dementia are managed to prevent falls, and documentation of hospital falls.
CONCLUSIONS: Evidence-based hospital falls guidelines are now available, yet systematic implementation across the hospital sector is more limited. There is a need to ensure an integrated and consistent approach to evidence-based falls prevention for a diverse range of hospital patients.
摘要：
背景：医院跌倒仍然是一个持续存在的全球性问题，对患者和卫生服务造成严重的有害后果。现在有许多针对医院跌倒的临床实践指南，有必要评估建议。
方法：对全球文献进行了系统回顾和批判性评估，符合系统审查和荟萃分析指南的首选报告项目。WebofScience,Embase,CINAHL,MEDLINE,认识论，临床实践指南信息库，从1993年1月1日至2024年2月1日检索了CochraneCENTRAL和PEDro数据库。指南的质量由两名独立审稿人使用《研究和评估指南评估》全球评级量表和《研究和评估推荐指南评估》（AGREE-REX）进行评估。调查结果的确定性使用建议评估分级进行评级，从定性研究评论中对证据的发展和评价信心。使用专题综合分析数据。
结果：筛选了2404条记录，77评估资格，纳入20份医院跌倒指南.十个人的AGREE-REX质量得分很高。主要分析主题如下：(I)入院时对跌倒风险筛查的支持不一，但是不再推荐使用评分筛查工具；（ii）建议对老年或体弱患者进行全面的跌倒评估；（iii）一贯推荐单因素和多因素跌倒干预措施；（iv）患者在指南制定和实施方面存在很大差距；（v）实施障碍包括工作人员和患者跌倒教育应如何进行的含糊不清，谵妄和痴呆是如何预防跌倒的，和医院跌倒的文件。
结论：现在有循证医院跌倒指南，然而，整个医院部门的系统实施更加有限。有必要确保对各种医院患者采取综合和一致的基于证据的跌倒预防方法。
方法：对全球文献进行了系统回顾和批判性评估，符合系统审查和荟萃分析指南的首选报告项目。WebofScience,Embase,CINAHL,MEDLINE,认识论，临床实践指南信息库，从1993年1月1日至2024年2月1日检索了CochraneCENTRAL和PEDro数据库。指南的质量由两名独立审稿人使用《研究和评估指南评估》全球评级量表和《研究和评估推荐指南评估》（AGREE-REX）进行评估。调查结果的确定性使用建议评估分级进行评级，从定性研究评论中对证据的发展和评价信心。使用专题综合分析数据。
结果：筛选了2404条记录，77评估资格，纳入20份医院跌倒指南.十个人的AGREE-REX质量得分很高。主要分析主题如下：(I)入院时对跌倒风险筛查的支持不一，但是不再推荐使用评分筛查工具；（ii）建议对老年或体弱患者进行全面的跌倒评估；（iii）一贯推荐单因素和多因素跌倒干预措施；（iv）患者在指南制定和实施方面存在很大差距；（v）实施障碍包括工作人员和患者跌倒教育应如何进行的含糊不清，谵妄和痴呆是如何预防跌倒的，和医院跌倒的文件。
结论：现在有循证医院跌倒指南，然而，整个医院部门的系统实施更加有限。有必要确保对各种医院患者采取综合和一致的基于证据的跌倒预防方法。
