个性化干预模式在老年住院患者药物相关性跌倒知行力中的应用研究

Improving the Knowledge and Behavior of Drug-related Falls in Elderly Hospitalized Patients by Individualized Intervention

目的通过个性化干预模式在提高老年住院患者对跌倒相关性药物知识的认知度,改善老年患者药物相关性跌倒的安全防范行为,减少药物相关性跌倒的发生。方法 2017年9月18日—2017年12月8日在5所三甲医院神经内科、骨科、肾内科、老年科住院的160例有服用降糖药、精神类药物或四种及以上高危易致跌倒药物的老年患者(年龄≥65岁),随机分为对照组和试验组,每组各80例,对照组按照常规入院防跌倒宣教,悬挂防跌倒温馨提示卡,常规发药及宣教;试验组在常规组的基础上通过详细告知患者易致跌倒药物的作用,在药袋上加盖防跌倒印章并告知标识的意义,发放彩色的所服用药物宣教单,告知患者服药后的跌倒防范注意事项,对患者进行全面评估,体格检查,根据病情及服药情况进行许可范围内的运动,包括增强肌肉力量的练习、步态练习和平衡练习,并在床头卡上做好特制的药物防跌倒标识,告知每班护士提醒、关注、干预患者的行为。使用3个五等级李克特量表,用于测量两组患者对药物相关性跌倒的认知、行为、状态的得分情况,通过独立样本t检验、卡方检验对两组干预后的结果进行评价。结果通过药袋上防跌倒印章的提醒,个性化的药物知识宣教和防范行为的落实,试验组80名住院老年患者的认知、行为、状态得分均高于对照组得分。结论此个性化干预模式可提高老年住院患者对药物相关性跌倒的知行力,可降低药物相关性跌倒的发生率,值得在今后的服药后的防跌倒宣教中进行推广,使更多的需长期服药或多药共服的慢性病老年患者受益。

Objective To improve the cognition of elderly inpatients for fall-related drugs through personalized intervention mode, improve the safety behaviors for drug related fall among elderly inpatients, and reduce the incidence of drug-related falls. Methods From November 1, 2017 to November 30, 2017, 160 elderly inpatients(over 65 years) who took hypoglycemic agents, psychotropic drugs or more than four high-risk drugs causing falls from the departments of neurology,nephrology, orthopedics, geriatric ward of five grade A class 3 hospitals, were selected and randomly allocated into intervention group(n=80) and control group(n=80). The control group patients were given traditional admission education for fall prevention, hung warm tips cards, regularly given drugs and education. Based on the traditional methods, the intervention group patients were informed of the effects of fall-risk drugs, the meaning of fall-preventing identification seals that were stamped on the medicine bags, were given the colorful issued medicine education brochures, and were informed the fall-preventing attention points after taking those medicines. The patients were given comprehensive assessment, physical examination, appropriate exercise within the allowable condition of the disease, including muscle strength exercises, gait exercises and balance exercises;Fall-preventing logo about special drugs was suspended on bed to make each nurse pay attention to and intervene the behavior of patients. We measured the cognition for fall-related drugs, behavior, state scores of two groups by three five-point Likert scale. t test and chi-square test were used to assess results of two groups before and after interventions. Results The cognitive, behavioral, and status scores of 80 elderly inpatients in the intervention group were higher than those in control group. Conclusions This personalized intervention model can improve the cognition of drug associated falls of elderly inpatients, reduce the incidence of drug-related fall, that should be promoted in high-risk falling prevention education in the future. It is also beneficial for elderly chronic diseases patients who need to take multidrugs or long-term medication.