engleski

Patient safety - best practices for falls reduction

Patient fall in hospitals is one of the serious errors in medical practice as it often results in consequences which can, to a greater or lesser extent, affect further quality of patient’s life. At the same time patient fall can have negative implications for the health institution in which the patient is being treated and for the health system as a whole. In almost every case, the fall extends treatment, increases treatment costs, and the reputation of the health institution may be significantly damaged. The number of patient falls in a health insti-tution is considered one of the most important indicators of quality of medical care, particularly the indicator of the level of patient safety.Aim: The research is related to monitoring the frequency of patient falls and their causes with the aim of improving the quality of nurses’ work in relation to health care quality indicator – patient fall.methodology: The research was conducted in three Surgery Clinics in Zagreb, in the period between 1 January 2011 and 31 December 2013. It included all patients hospitalized in the clinics over the course of these three years. Data were collected in accordance with the Standards of procedure for fall prevention and post-fall treatment.results and discussion: The results showed that the incidence of falls in 2013, compared to research in the previous two years (2011 and 2012) increased significantly. In contrast to 2012, the rate of patient falls in 2013 increased twofold, and in relation to 2011 it was three times as much. The established patient fall rates (0.22 to 0.68) were significantly lower than those specified in other relevant research (between 2.9 and 13 falls per 1, 000 days of hospital treatment).This research has also focused on certain intrinsic risk factors - gender, age, confusion and disorientation ; and extrinsic risk factors - time/part of the day when patient falls usually occurred.In relation to risk factor relating to gender, relevant worldwide research has shown that the fall incidence in women is greater by 3.8% than in men. Our research has also shown that, if we take into account the re-ported falls, that is a significantly higher proportion of women than men (52.4 % of women versus 47.6 % of men). It was also found that the number of falls in women over 65 years of age increases, but that other ad-ditional risk factors should be taken into consideration: malnutrition and sarcopenia as geriatric syndromes that occur at that age.Our research confirmed the results of other research in which patients’ falls, regardless of the gender, were significantly more frequent in the age groups over 65 years of age. The percentage of falls in 2011, 2012 and 2013, in patients over 65, ranged from 75 % to 81 %, compared to a younger age.Even though many authors cite confusion as one of the most important risk factors in patient falls, in this research, confusion or disorientation caused 18.8 % of all falls in 2011, 17.0 % in 2012 and 19.2 % in 2013, comes after the risk factors of dizziness or general weakness (cause of 25.0 % of all falls in 2011, 53.2 % in 2012 and 53.9 % of falls in 2013). Data collected in this research clearly shows that dizziness or general weakness are statistically the most significant and the most common causes of falls in hospital-ized patients.The extrinsic risk factors included in the study were the time/part of day when falls most frequently occurred. The results showed that most patients’ falls occur during the night, which was also confirmed by other stud-ies. In the analysis of pooled data for all the years included in the research, the number of patients who had fallen during the night was almost one-third of all patients. When analyzing the ratio of the number of falls in the evening and the number of falls during the night, it was found that 60 % of falls occur at night. conclusion: Systematic risk assessment of falls and fall injuries, implementation and evaluation of falls and injury prevention programs, multiple interventions, multidisciplinary approach, staff and patient education and family involvement, increasing staff awareness, stressing the importance of supervision to prevent falls, data collection, trends analysis, reporting on falls in multidisciplinary meetings and changes in the environ-ment are certainly valuable measures to improve nursing practice and increase patient safety.

patient falls ; quality indicator ; risk factors ; prevention

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