奈良県立医科大学付属病院入院患者の転倒・転落事故リスク要因に関する前向き調査

Abstract

Slip-and-fall of inpatients is a frequent and risky accident. It is difficult for nursing to prevent these accidents because they often occur along with a patient's voluntary action. Intensive observation of the patients at risk based on estimation of their risk levels is considered to be efficient. For this purpose, it is important to determine significant risk factors. Thus we conducted a prospective study on risk factors of slip-and-fall and established a scoring system to recognize patients at risk. In 1,922 inpatients, possible risk factors were systematically examined when on admission to our hospital, and the occurrence of slip-and-fall was observed during the period of hospitalization. Then relative risk values of the study factors were calculated, and these probabilities were converted to scores. Finally, 47 patients (2.4%) experienced a slip-and-fall accident. Each of the significantly higher risk factors was closely related to "limited activity", "poor cognition", "action for excretion", or "device- or nurse-assisted movement". The most discriminative cut-off score obtained from our scoring system showed the sensitivity of 66%, the specificity of 82%, the positive predictive value of 8%, and the negative predictive value of 99%. This cut-off score may be useful for screening the patients who are not in need of intensive observation. However, considering several limitations of this study, this system should be verified and improved in future.