使用離床報知機偵測離床降低住院病人跌倒之研究

The Effects of the Bed-Exit Alarm System on Fall Prevention in a Medical Center

10.6142/VGHN.33.2.164

林小玲(Shir-Ling Lin)；謝雅宜(Ya-I Hsieh)；溫明寰(Ming-Huan Wen)

離床報知機 ； 跌倒 ； 住院病人 ； 診斷型分析 ； bed-exit alarm ； fall ； acute care setting ； diagnostic test

榮總護理

33卷2期（2016 / 06 / 01）

164 - 175

繁體中文

離床報知機對預防住院病人跌倒之成效不一，本研究目的為評估離床報知機是否可有效偵測病人離床，及是否減少住院老人跌倒異常事件的發生。本研究為兩組前瞻式追蹤觀察型設計，計算離床報知機偵測病人離床之敏感性及特異性，與比較離床報知機使用前後各半年跌倒發生率之差異。第一部份共收集175 位符合適應症、使用離床報知機病人之機器警示資料，由護理人員每日工作中以記錄表收集資料，在台北某醫學中心4個病房收案。第二部份則先收集未正確使用離床報知機時病人是否跌倒之資料，再收集正確使用離床報知機時病人是否跌倒之資料。資料分析：離床報知機準確度採用Diagnostic test分析；病人屬性與是否跌倒，使用X^2 test與相關危險度檢定。主要結果：一、離床報知機之敏感性為94.4%、特異性為73.5%，陽性預測值為68.9%，陰性預測值為95.4%，而相似比為3.56；二、未依照離床報知機作業標準，跌倒發生率0.166%；依照離床報知機制訂標準作業流程執行，跌倒發生率0.126%；三、離床報知機適用族群稽核監測遵從率為81.4%，正確性監測為97.3%；四、使用離床報知機能降低17.2%跌倒發生風險。本研究搜尋國內外研究相關文獻，製作離床報知機標準作業規範，藉由修訂住院病人預防跌倒執行對策、並善用離床報知機，期望降低住院老人跌倒發生率、跌倒傷害率，降低醫療成本，確保病人獲得完善的照護。

Most falls in acute care settings occur in the rooms of patients, especially during attempts to get in or out of bed. Bed-exit alarms were designed to detect patients moving out of their beds, thereby increasing staff surveillance of cognitively and/or physically impaired patients at risk for bed-related falls. However, the overall reliability of bed-exit alarms in detecting patient movements out of bed has not been clearly established. The purpose of this study is to develop an evidencebased bed-exit alarm care guideline for patients in acute care settings and to provide comprehensive strategic care plans for fall prevention among these patients. This research was conducted through a two-group, 6-month cohort perspective study to investigate the effectiveness of bed-exit alarms in preventing falls among patients in acute care settings. The relative ratio of falls, injury-related falls and fall rates in the two groups were computed and analyzed. The accuracy of the bed-exit alarms was calculated. The main findings were as follows: (1) the sensitivity, specificity, and likelihood ratio of the bed-exit alarm were 94.4%, 73.5%, and 3.56, respectively, for detecting when high fallrisk patients exited their beds; (2) the fall rate of the regularly performed bed-exit alarm cohort group was 0.126% and the fall rate of the nonregularly performed bed-exit alarm cohort group was 0.166%; (3) the adherence rate of nurses for performing the evidence-based bed-exit alarms care guideline was 81.4%; (4) the absolute risk reduction from using the bed-exit alarm was 17.2%. The result of this study is to develop a bed-exit alarm care guideline for patients and to implement an intervention to judge appropriateness in applying a bed-exit alarm system. Furthermore, it is recommended to expand this bed-exit alarm care guideline to other institutions.

1. 林小玲、溫明寰、陳玉枝(2010)。跌倒危險評估量表準確度之研究。醫護科技學刊，12(1)，47-59。
   連結：
2. 林茂榮、黃慧芬(2008)。老人跌倒之預防介入策略。台灣公共衛生雜誌，27(6)，447-462。
   連結：
3. Anderson, O.,Boshier, P. R.,Hanna, G. B.(2012).Interventions designed to prevent healthcare bed-related injuries in patients.Cochrane Database of Systematic Reviews,1,CD008391.
4. Cameron, I. D.,Murray, G. R.,Gillespie, L. D.,Robertson, M. C.,Hill, K. D.,Cumming, R. G.,Kerse, N.(2010).Interventions for preventing falls in older people in nursing care facilities and hospitals.Cochrane Database of Systematic Reviews,1,CD005465.
5. Capezutia, E.,Brush, B. L.,Lane, S.,Rabinowitzd, H. U.,Secic, M.(2009).Bed-exit alarm effectiveness.Archives of Gerontology and Geriatrics,49(1),27-31.
6. Diduszyn, J.,Hofmann, M. T.,Naglak, M.,Smith, D. G.(2008).Use of a wireless nurse alert fall monitor to prevent inpatient falls.The Journal of Clinical Outcomes Management,15(6),293-296.
7. Gates, S.,Lamb, S. E.,Fisher, J. D.,Cooke, M. W.,Carter, T. H.(2008).Multifactorial assessment and targeted intervention for preventing falls and injuries among older people in community and emergency care settings: Systematic review and meta-analysis.British Medical Journal,336(7636),130-133.
8. Gillespie, L. D.,Robertson, M. C.,Gillespie, W. J.,Lamb, S. E.,Gates, S.,Cumming, R. G.,Rowe, B. H.(2009).Interventions for preventing falls in older people living in the community.Cochrane Database of Systematic Reviews,2
9. Hemple, S.,Newberry, S.,Wang, Z.,Booth, M.,Shanman, R.,Johnsen, B.,Ganz, D. A.(2013).Hospital Fall Prevention: A Systematic Review of Implementation, Components, Adherence, and Effectiveness.Journal of the American Geriatrics Society,61(4),483-494.
10. Hilbe, J.,Schulc, E.,Linder, B.,Them, C.(2010).Development and alarm threshold evaluation of a side rail integrated sensor technology for the prevention of falls.International Journal of Medical Informatics,79(3),173-180.
11. Hubbart, B.,Davis, S. G.,Kautz, D. D.(2011).Nurses' experiences with bed exit alarms may lead to ambivalence about their effectiveness.Rehabilitation Nursing,36(5),196-199.
12. Lloyd, T.(2011).Creation of a multiinterventional fall-prevention program using evidence-based practice to identify high-risk units and tailor interventions.Othopaedic Nursing,30(4),249-257.
13. Nelson, A.,Powell-Cope, G.,Gavin-Dreschnack, D.,Quigley, P.,Bulat, T.,Baptiste, A. S.,Friedman, Y.(2004).Technology to promote safe morbility in the elderly.Nursing Clinics of North America,39(3),649-671.
14. Shaw, F. E.,Bond, J.,Richardson, D. A.,Dawson, P.,Steen, I. N.,McKrith, I. G.,Kenny, R. A.(2003).Multifactorial intervention after a fall in older people with cognitive impairment and dementia presenting to the accident and emergency department: Randomized controlled trail.British Medical Journal,326(7380),73-75.
15. Shorr, R. I.,Chandler, M. A.,Mion, L. C.,Waters, T. M.,Liu, M.,Daniels, M. J.,Miller, S. T.(2012).Effects of an intervention to increase bed alarm use to prevent falls in hospitalized patients-a cluster randomized trial.Annals of Internal Medicine,157(10),692-699.
16. Tideksaar, R.,Feiner, C. F.,Maby, J.(1993).Fall prevention: The efficacy of a bed alarm system in an acute-care setting.Mount Sinai Journal of Medicine,60(6),522-527.
17. Vass, C. D.,Sahota, O.,Drummond, A.,Kendrick, D.,Gladman, J.,Sach, T.,Grainge, M.(2009).REFINE (Reducing Falls in In-patient Elderly)- a randomized controlled trial.Trial,10,83.
18. Ward-Smith, P.,Barrett, L.,Rayson, K.,Govro, K.(2015).Effectiveness of a bed alarm system to predict falls in an acute care setting.Clinical Nursing Studies,3(1),1-4.
19. 康家豪、王文揚、李政翰、施維哲(2007)。應用資通技術於長期照護之危險偵測。長期照護雜誌，11(4)，370-380。
20. 郭英調(2000)。臨床研究手冊。台北:合慶圖書公司。
21. 羅元婷、羅慶徽、朱明若、許佩榮、張俊喜、林金定(2007)。跌倒防治策略之探討。台灣老人保健學刊，3(1)，14-29。

1. 蔡雅存,翁御靜,洪雅淇,洪富如,林資諺,林良餘(2023)。提升護理師運用智慧臥床照護系統執行率。榮總護理，40(3)，306-312。
2. (2024)。從人工智慧視野反思防跌AI模式之開發。醫務管理期刊，25(1)，66-80。