混合病棟における転倒・転落に関連したインシデントの要因分析と新しいアセスメントスコアの提案

Abstract

A slip-and-fall assessment score sheet is filled out by a nurse for all inpatients to recognize which of them are more likely to fall, and assist them. Although the sheet is used daily in a mixed medical ward (Departments of Internal Medicine, Otorhinolaryngology, and General Medicine) in Nara Medical University Hospital, the sheet was originally established based on slip-and-fall cases that had arisen in a department of neurosurgery or orthopedic surgery. So we wondered, whether the sheet would also work effectively in a mixed medical ward that manages a greater variety of medical treatments and disease situations. Therefore, in this study, we gathered the slip-and-fall incident reports (77 persons) and clarified the characteristics and actual condition of the inpatients who had fallen. And we compared the scores obtained by the inpatients who had fallen (78 persons) and the inpatients who had not fallen (178 persons) for each item, and found the items that showed a significant difference in the averaged scores between these groups of inpatients. Following the results, we calculated odds ratios by multiple logistic regression using only the items with the significant differences, and improved the scoring system to suit the mixed medical ward. The actual condition survey established the fact that the inpatients have often fallen in their own room during the night. Inpatients with a previous history of falling, aged inpatients, and inpatients with physical pain were especially likely to fall, because the scores obtained by the inpatients who had fallen were significantly higher than those of the inpatients who had not fallen in the items that related to falling history, age, and pain. The proposed scoring system could make the difference in the scores obtained by inpatients who have fallen and those who have not broader, making it possible to detect the inpatients who might fall with higher accuracy in a mixed medical ward.