降低住院患者跌倒发生率的项目管理效果评价

Effect evaluation of project management to reduce the incidence of inpatients'falls

目的运用项目管理方法,降低住院患者跌倒发生率。方法以整群抽样法选取2019年1月至12月南方医科大学顺德医院全部31个住院科室全部住院患者中发生跌倒117例为对照组,男58例、女59例,年龄(64.52±17.04)岁。开展跌倒项目管理后的2021年1月至12月住院跌倒患者80例为试验组,男47例、女33例,年龄(65.19±16.51)岁。2020年成立住院患者预防跌倒项目管理小组,负责全院住院患者跌倒预防与跌倒事件处理的技术支持与质量管理,流程培训与数据分析等。护士与医生、药师共同参与,开展一体化查房和落实宣教措施,总务后勤和设备部门解决环境与设施问题。通过对2017年至2019年住院跌倒患者资料分析,将安全用药和安全如厕作为项目改善的重点,在常规跌倒风险评估基础上增加平衡能力测试、起步计时测试、体位性低血压测试、跌倒独立风险因素管理、项目小组成员定期检查督导和组织护理会诊等加强科室预防跌倒管理,对跌倒个案进行访谈和根本原因分析,制定有效改进措施避免类似事件再发生。采用χ^(2)检验。结果住院患者跌倒发生率由2019年的0.197‰下降至2021年的0.151‰,患者如厕相关活动致跌倒占比由2019年的50.4%(59/117)下降至2021年的35.0%(28/80),用药致跌占比由2019年的68.4%(80/117)下降至2021年的51.3%(41/80),跌倒伤害由2019年的67.5%(79/117)下降至2021年的38.8%(31/80),差异均有统计学意义(均P<0.05)。结论多部门合作跌倒项目管理能有效降低跌倒发生率和伤害率,提升住院患者预防跌倒管理效果。

Objective To reduce the incidence of inpatients'falls by using project management method.Methods A total of 117 cases of falls among all patients in 31 inpatient departments of Shunde Hospital of Southern Medical University from January to December 2019 were selected as a control group by the cluster sampling method,including 58 males and 59 females,aged(64.52±17.04)years.A total of 80 hospitalized fall patients from January to December 2021 after fall project management were included in the experimental group,including 47 males and 33 females,aged(65.19±16.51)years.In 2020,a project management team for inpatients'fall prevention was set up,responsible for the technical support and quality management,process training,and data analysis of fall prevention and fall event treatment for the inpatients in the whole hospital.Nurses,doctors,and pharmacists participated in the management together and conducted the integrated ward rounds and educational measures,and the general logistics and equipment departments solved the environmental and facility problems.By analyzing the data of inpatients'fall from 2017 to 2019,safe medication and safe toilet use were selected as the key points of project improvement.On the basis of routine fall risk assessment,balance ability test,start-up timing test,postural hypotension test,independent risk factor management of falls,regular inspection and supervision by project team members,and organization of nursing consultation were added to strengthen the fall prevention management in the departments.The interviews and root cause analysis were conducted on fall cases,and the effective improvement measures were formulated to avoid the recurrence of similar events.χ^(2) test was used.Results The incidence of falls among the inpatients decreased from 0.197‰in 2019 to 0.151‰in 2021,the proportion of falls caused by toilet related activities decreased from 50.4%(59/117)in 2019 to 35.0%(28/80)in 2021,the proportion of fall caused by drug use decreased from 68.4%(80/117)in 2019 to 51.3%(41/80)in 2021,and the injury rate of falls decreased from 67.5%(79/117)in 2019 to 38.8%(31/80)in 2021,with statistically significant differences(all P<0.05).Conclusion Multi-department cooperative fall project management can effectively reduce the incidence and injury rate of falls,and improve the management effect of inpatients'fall prevention.