■跌倒是急性医院报告的最常见的安全事件。国家健康与护理卓越研究所建议进行多因素跌倒风险评估和量身定制的干预措施,但实现是可变的。
■确定如何以及在什么情况下,多因素跌倒风险评估和量身定制的干预措施被用于英格兰急性国家卫生服务医院。
■现实主义综述和多站点案例研究。(1)系统搜索,以确定利益相关者的理论,使用初步研究的经验数据进行检验。急性信托预防跌倒政策回顾。(2)通过观察进行理论检验和提炼,员工面试(n=50),患者和护理人员访谈(n=31)和记录回顾(n=60)。
■三个信托,每个都有一个骨科病房和一个老年人病房。
■78项研究用于理论构建,50项用于理论测试。探索了四种理论。(1)领导能力:病房将跌倒与从业人员联系在一起,但为预防跌倒分配资源的权力由高级护士拥有。(2)分担责任:预防跌倒的关键策略是患者监督。这要归功于护理人员,限制预防跌倒的责任可以分担的程度。(3)便利:评估记录一致,但工作量压力可能会将其减少到打勾的工作。评估项目多种多样。虽然确定了个别患者的危险因素,患者被分类为高风险或低风险,以确定谁应该接受监督.(4)患者参与:护理人员没有时间向患者解释其跌倒风险或如何防止自己跌倒,虽然其他工作人员可以这样做。敏感的沟通可以防止患者采取增加跌倒风险的行动。
■在现实主义审查中,我们只完成了两种理论的综合。我们无法在观察之前访问患者记录,防止评估是否制定了护理计划。
■(1)领导力:应明确区分高级护士的角色和跌倒将预防跌倒的从业人员联系起来;(2)共同责任:信托应考虑流程和系统,包括电子健康记录,可以修改以更好地支持多学科方法,应考虑患者监督的替代方案;(3)促进:信托应考虑如何减轻文件负担并避免勾选反应,并确保跌倒风险评估工具中包含的项目与指导一致。跌倒风险评估工具和跌倒护理计划应作为支持实践的工具。(4)患者参与:信托应考虑如何确保患者获得有关风险和预防跌倒的个性化信息,并为工作人员提供简短但敏感的方式与患者交谈的指导,以减少增加跌倒风险的行为的可能性。
■(1)制定和评估干预措施,以支持多学科团队开展,让病人参与进来,多因素跌倒风险评估以及选择和提供量身定制的干预措施;(2)患者监督的混合方法和经济评估;(3)参与支持工作者的评估,志愿者和/或护理人员支持预防跌倒。研究应包括认知障碍患者和不会说英语的患者。
■本研究注册为PROSPEROCRD42020184458。
■该奖项由国家健康与护理研究所(NIHR)健康与社会护理提供研究计划(NIHR奖参考:NIHR129488)资助,并在《健康与社会护理提供研究》中全文发表。12号5.有关更多奖项信息,请参阅NIHR资助和奖励网站。
许多老年人在医院意外跌倒是可以避免的。有防止跌倒的指导方针,但是有些医院比其他医院更擅长跟踪他们。本研究旨在找出原因。首先,我们研究了研究和医院的跌倒政策,以了解如何阻止跌倒。根据服务用户的建议,我们在英国的四家医院测试了这些想法,观察如何防止老年人和需要骨骼护理的人跌倒,和50名员工交谈,28名患者和3名护理人员。我们发现了以下内容:瀑布领导:病房有工作人员称为跌倒链接从业者,他们支持跌倒预防,但是高级护士,不联系从业者,做出了最重要的决定.分担责任:对有跌倒风险的患者进行监测,以试图阻止跌倒。因为只有护理团队总是在场监测病人,他们对防止跌倒负有最大责任。这限制了与其他工作人员的分担责任。电脑工具:护士用电脑记录预防工作,但是高工作量可能会使这成为“复选框”练习。电脑工具提醒他们这样做,虽然工具多种多样。患者有个人跌倒计划,但他们也被普遍列为跌倒风险高或低,对“高危”患者进行监测。患者参与:护理人员没有时间向患者解释如何预防跌倒,但是其他员工可以进行这样的对话。许多患者有痴呆症等问题,发现很难遵循安全建议,尽管有些人可以采取措施保持安全,在敏感的员工支持下。我们需要让病人参与进来,护理人员和预防跌倒的不同工作人员。医院可以开发计算机系统来支持这一点,想想如何让更多的病房工作人员参与进来,并提供有关与患者谈论跌倒的有用方法的指导。
UNASSIGNED: Falls are the most common safety incident reported by acute hospitals. The National Institute of Health and Care Excellence recommends multifactorial falls risk assessment and tailored interventions, but implementation is variable.
UNASSIGNED: To determine how and in what contexts multifactorial falls risk assessment and tailored interventions are used in acute National Health Service hospitals in England.
UNASSIGNED: Realist review and multisite case study. (1) Systematic searches to identify stakeholders\' theories, tested using empirical data from primary studies. Review of falls prevention policies of acute Trusts. (2) Theory testing and refinement through observation, staff interviews (n = 50), patient and carer interviews (n = 31) and record review (n = 60).
UNASSIGNED: Three Trusts, one orthopaedic and one older person ward in each.
UNASSIGNED: Seventy-eight studies were used for theory construction and 50 for theory testing. Four theories were explored. (1) Leadership: wards had falls link practitioners but authority to allocate resources for falls prevention resided with senior nurses. (2) Shared responsibility: a key falls prevention strategy was patient supervision. This fell to nursing staff, constraining the extent to which responsibility for falls prevention could be shared. (3) Facilitation: assessments were consistently documented but workload pressures could reduce this to a tick-box exercise. Assessment items varied. While individual patient risk factors were identified, patients were categorised as high or low risk to determine who should receive supervision. (4) Patient participation: nursing staff lacked time to explain to patients their falls risks or how to prevent themselves from falling, although other staff could do so. Sensitive communication could prevent patients taking actions that increase their risk of falling.
UNASSIGNED: Within the realist review, we completed synthesis for only two theories. We could not access patient records before observations, preventing assessment of whether care plans were enacted.
UNASSIGNED: (1) Leadership: There should be a clear distinction between senior nurses\' roles and falls link practitioners in relation to falls prevention; (2) shared responsibility: Trusts should consider how processes and systems, including the electronic health record, can be revised to better support a multidisciplinary approach, and alternatives to patient supervision should be considered; (3) facilitation: Trusts should consider how to reduce documentation burden and avoid tick-box responses, and ensure items included in the falls risk assessment tools align with guidance. Falls risk assessment tools and falls care plans should be presented as tools to support practice, rather than something to be audited; (4) patient participation: Trusts should consider how they can ensure patients receive individualised information about risks and preventing falls and provide staff with guidance on brief but sensitive ways to talk with patients to reduce the likelihood of actions that increase their risk of falling.
UNASSIGNED: (1) Development and evaluation of interventions to support multidisciplinary teams to undertake, and involve patients in, multifactorial falls risk assessment and selection and delivery of tailored interventions; (2) mixed method and economic evaluations of patient supervision; (3) evaluation of engagement support workers, volunteers and/or carers to support falls prevention. Research should include those with cognitive impairment and patients who do not speak English.
UNASSIGNED: This study is registered as PROSPERO CRD42020184458.
UNASSIGNED: This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR129488) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 5. See the NIHR Funding and Awards website for further award information.
Many accidental falls by older people in hospitals could be avoided. There are guidelines to prevent falls, but some hospitals are better at following them than others. This study aimed to find out why. First, we looked at research and hospitals’ falls policies for ideas about what stops falls. With advice from service users, we tested these ideas in four hospitals in England, watching how falls were prevented on wards for older people and people who need bone care, and talking to 50 staff, 28 patients and 3 carers. We found the following: Falls leadership: wards had staff called falls link practitioners who supported falls prevention, but senior nurses, not link practitioners, made the most important decisions. Sharing responsibility: patients with falls risks were monitored to try to stop falls. Because only nursing teams were always present to monitor patients, they had most responsibility for preventing falls. This limited sharing responsibility with other staff. Computer tools: nurses used computers to record prevention work, but high workloads could make this a ‘tick-box’ exercise. Computer tools reminded them to do this, although tools varied. Patients had individual falls plans, but they were also ranked more generally as high or low risk of falling, with ‘high-risk’ patients being monitored. Patient involvement: nursing staff did not have time to explain to patients how to prevent falls, but other staff could have such conversations. Many patients had problems like dementia and found it difficult to follow safety advice, although some could take steps to keep safe, with sensitive staff support. We need to involve patients, carers and different staff in falls prevention. Hospitals could develop computer systems to support this, think how to involve more ward staff, and provide guidance on helpful ways to talk with patients about falls.