Fall Risk Factors Assessment Tool: Enhancing Effectiveness in Falls Screening

跌倒危險因子評估新表對提高跌倒篩檢率之成效

徐姍姍(Shan-Shan Hsu)；李春蘭(Chun-Lan Lee)；王淑蓉(Shu-Jung Wang)；徐霜(Shuang Shyu)；曾修儀(Hsiu-Yi Tseng)；雷玉華(Yu-Hua Lei)；李從業(Tsorng-Yeh Lee)

跌倒危險因子 ； 跌倒篩檢 ； 跌倒預防措施 ； fall risk factors ； fall screening ； fall prevention program

The Journal of Nursing Research

12卷3期（2004 / 09 / 01）

169 - 179

英文

A quasi-experimental study was conducted to explore the effectiveness of fall prevention among hospital patients based on the modified fall risk factors assessment tool. We investigated the frequency of falls among hospital patients at a medical center in Taiwan. The experimental group of falls victims was selected from patients (n = 39) hospitalized in 2002 after falls. The control group of patients falls was selected by means of a retrospective incident report review which identified patients (n = 43) hospitalized one year earlier. The results showed that there was no significant difference in the incidence of falls between the two groups. Nevertheless, there were significant differences in age, indications of falls, use of sedatives, walking ability and evaluated grade of fall risk factors. In addition, the average level of satisfaction under recently modified fall risk factors evaluation guideline was 2.68 points (upper limit = 4 points) based upon investigation derived from nursing staff’s opinions. Moreover, nursing staff from GYN/OBS and orthopedics departments acknowledged the enhanced effectiveness of these new guidelines. The screening rate for high-risk orthopedic patients was increased from 20.7% to 41.9%. Furthermore, the screening rate among the experimental group (74.4%) was also higher than that among the control group (60.5%) (p ＜ .01). In line with our effective tool to screen high-risk patients, we also added the concept of continuous quality improvement in nursing care to implement a fall prevention program to reduce unnecessary injury. This strategy may assist nursing personnel in providing immediate and individualized care as well as health education for high-risk patients. It may also cause the incidence of patient falls in hospitals to continue to decline.

A quasi-experimental study was conducted to explore the effectiveness of fall prevention among hospital patients based on the modified fall risk factors assessment tool. We investigated the frequency of falls among hospital patients at a medical center in Taiwan. The experimental group of falls victims was selected from patients (n = 39) hospitalized in 2002 after falls. The control group of patients falls was selected by means of a retrospective incident report review which identified patients (n = 43) hospitalized one year earlier. The results showed that there was no significant difference in the incidence of falls between the two groups. Nevertheless, there were significant differences in age, indications of falls, use of sedatives, walking ability and evaluated grade of fall risk factors. In addition, the average level of satisfaction under recently modified fall risk factors evaluation guideline was 2.68 points (upper limit = 4 points) based upon investigation derived from nursing staff’s opinions. Moreover, nursing staff from GYN/OBS and orthopedics departments acknowledged the enhanced effectiveness of these new guidelines. The screening rate for high-risk orthopedic patients was increased from 20.7% to 41.9%. Furthermore, the screening rate among the experimental group (74.4%) was also higher than that among the control group (60.5%) (p ＜ .01). In line with our effective tool to screen high-risk patients, we also added the concept of continuous quality improvement in nursing care to implement a fall prevention program to reduce unnecessary injury. This strategy may assist nursing personnel in providing immediate and individualized care as well as health education for high-risk patients. It may also cause the incidence of patient falls in hospitals to continue to decline.

1. Adrianne, J. L.(1999).Evaluation of the fall prevention program in an acute care setting.Orthopedic Nursing,18(6),31-37.
2. Chen, C. H.(1991).Investigation and research of hospitalized patients fall events.VGH Nursing,8(2),311.
3. Chen, L. Y.,Chen, S. E.,Li, J. Y.,Hsu, Y. N.(1998).Study on the preventing program of hospitalized patient of medicine wards.Hospital,31(6),78-81.
4. Chen, Y. C.,Line, L. H.,Jeng, S. F.(2002).The impacting factors of hospitalized patient injurious falls and the correlation with the consumption of medical resources.Tzu Chi Nursing Journal,1(3),66-76.
5. Chen. Y. C.,M. S. Lu(2001).Taiwan joint commission on hospital accreditation.Research on hospitalized patient falls related factors and their medical resource spending. Symposium conducted at the 2nd anniversary meeting of the Taiwan Quality Indicator Project,Taipei:
6. Chu, L.W.,Pei, C. K. W.,Chiu, A.,Liu, K.(1999).Risk factors for falls in hospitalized older medical patients.The Journal of Gerontology,54(1),38-43.
7. Daubney, M. E.,Culham, E. G.(1999).Lower-extremity muscle force and balance performance in adults aged 65 years and older.Physical Therapy,79(12),1177-1185.
8. Eagle, D. J.,Salama, S.,Whitman, D.,Evans, L. A.,Olde, J.(1999).Comparison of three instruments in predicting accidental falls in selected inpatients in a general teaching hospital.Journal of Gerontological Nursing,25(7),40-46.
9. Everitt, V.,Bridel-Nixon, J.(1997).The use of bed rails: Principles of patient assessment.Nursing Standard,12(6),44-47.
10. Guelich, M. M.(1998).Prevention of falls in the elderly: A literature review.Top Geriatric Rehabilitation,15(3),253-265.
11. Huang, T. J.,Liu, S. C.,Chang, C. F.,Wu, S. J.(1998).Investigation on the effects of Patient Fall Preventing Program.VGH Nursing,15(3),253-265.
12. Ignatavicius, D.(2000).Do you help staff rise to the fall-prevention challenge?.Nursing Management,31(1),27-31.
13. Irvin, D. J.(1999).Psychiatric unit fall events.Journal of Psychosocial Nursing & Mental Health Services,37(12),8-16, 39-40.
14. Loew, F.,Registe-Rameau, Y.,Kressing, R.,Marcant, D.,Herrmann, F. R.,Michel, J. P.,J. P. Michel (Eds.),P. R. Hof (Eds.)(1999).Management of aging.Basel, Switzerland:S. Karger.
15. McCloskey, J. M.(1998).Staffing and patient outcomes.Nursing Outlook,46(5),199-200.
16. Olover, D.,Britton, M.,Seed, P.,Martin, F. C.,Hopper, A. H.(1997).Development and evaluation of evidence based risk assessment tool (SATRATIFY) to predict which elderly inpatients will fall: Case-control and cohort studies.British Medical Journal,315(7115),1049-1053.
17. Rutledge, D. N.,Donaldson, N. E.,Parvikoff, D. S.(1998).Fall risk assessment and prevention in healthcare facilities.Online Journal of Clinical Innovations,1(9),1-33.
18. Schmid, N. A.(1990).Reducing patient falls: A research-based comprehensive fall prevention program.Military Medicine,155,202-207.
19. Schwartz, A. V.,Villa, M. L.,Prill, M.,Kelsey, J. A.,Galinus, J. A.,Delay, R. R.(1999).Fall in older Mexican-American women.Journal of the American Geriatrics Society,47(11),1371-1379.
20. Tinetti, M. E.,Baker, D. I.,McAvay, G.,Claus, E. B.,Garrett, P.,Gottschalk, M.(1994).The multifactorial intervention to reduce the risk of falling among elderly people living in the community.The New England Journal of Medicine,331(13),821-827.
21. Vassallo, M.,Amersey, R. A.,Sharma, J. C.,Allen, S. C.(2000).Falls on integrated medical wards.Gerontology,46(3),158-162.

1. 曾淑芬、陳惠芳、郭姵伶、王淑慧(2011)。機構式長期照護住民之跌倒危險性探討。嘉南學報（人文類），37，365-374。
2. 楊斐卿、曾惠珍(2017)。簡化住院病人跌倒風險篩檢表。榮總護理，34(1)，98-108。
3. 鍾惠君,謝宗成,章淑娟,呂基燕(2015)。應用ROC曲線分析驗證精簡版住院病人跌倒危險因子評估工具之準確度研究。志為護理-慈濟護理雜誌，14(6)，62-73。