探討醫院異常事件通報病患發生跌倒事件之分析－以中部某區域教學醫院為例

Factors Influencing Inpatient Falls: An Analysis of the Medical Incident Reporting System-Using Data From a Regional Teaching Hospital in Central Taiwan

10.6220/joq.202204_29(2).0001

李晏華(Yan-Hua Li)；黃冠凱(Kuan-Kai Huang)；吳信宏(Hsin-Hung Wu)

異常事件通報系統 ； 跌倒事件 ； 關聯規則 ； critical incident reporting system ； falls ； association rule

品質學報

29卷2期（2022 / 04 / 30）

99 - 117

繁體中文

本研究以中部某區域教學醫院發生跌倒異常事件通報為例，探討哪些情況下跌倒將會發生以及病患跌倒後傷害程度之影響，作為今後預防跌倒事件之參考。因此本次研究藉由從「人」、「事」、「時」、「地」相關層面進行分析探討，蒐集資料為個案醫院2016年至2018年的異常事件通報系統（critical incident reporting system）的資料庫篩選出374筆有效資料。研究變項包括病患的年齡、性別、班別、科別、有無陪伴者、事件發生過程中有關聯的人員、跌倒的因素、跌倒後有無傷害、大小夜班及跌倒的地點。利用Apriori演算法的關聯規則（association rule）將提升度設定為大於1，信賴度設定為80%，支持度設定為5%，篩選過後得出32條規則並進一步整理成11條通則。從整理出來的11條通則的內容結果發現，當跌倒事件發生在白班的情況下，通常年齡在21～35歲的男性且有陪伴者或物理、職能治療人員在旁，與事件發生後對病人無傷害，跌倒相關因素為病患生理與行為，以及嚴重度（severity assessment code）評估為第四級。當跌倒發生在年齡65歲以上，病患性別為女性且有陪伴者或護理人員在旁，表明雖然有陪伴者或護理人員，但不表示病患絕對安全，跌倒單位在內科與事發後對病患是有傷害，跌倒相關因素為病人生理與行為，地點發生在一般病房（含病房走廊、浴室、護理站區域），時間會在大夜班以及嚴重度評估為第四級。當跌倒容易發生在男性病患的情況下，通常年齡在21～35歲且沒有陪伴者，跌倒相關因素為環境和病患生理與行為，地點發生在一般病房（含病房走廊、浴室、護理站區域），時間會在白班。

This study uses the medical incident reporting system in a regional teaching hospital in central Taiwan to analyze critical factors influencing inpatient falls in terms of people, event, time, and place. The research intends to explore how inpatient falls will occur and the impact of the degree of injury after falls, which can become a reference for the prevention of falls events in the future. The data with 374 transactions from 2016 to 2018 in this case regional teaching hospital from the medical incident reporting system were used. This study uses the following variables including age, gender, division, companions, people involved in the event, factors of falls, injuries after falls, night shifts, and places of falls. Apriori algorithm was applied to generate 32 rules which can be further organized into eleven general rules. The parameters of lift, confidence, and support are set to greater than 1, 80%, and 5%, respectively. Based on these 11 generalized rules, the results of the study showed that the inpatient falls occurs in the day shift, males between ages of 21 and 35, with companions or physical therapists with no harm to the patient. The relevant factors of falls are the physiology and behavior of the patient, and the severity is 4. The falls occurs at the age of 65 and above female patients with companions or nurses, indicating that the presence of a companion or caregiver does not mean that the patient is absolutely safe. The patient who falls in the division of general medicine is injured. The related factors are the physiology and behavior of the patient. The falls is in the general ward and in the night shift, and the severity is 4. The falls occurs in male patients between ages of 21 and 35 and have no companion. The related factors of falls are the environment and the physiology and behavior of the patients. The locations are in the general ward and the time is in the day shift.

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