HFEMA结合CATCH模型构建老年患者跌倒安全管理体系效果分析

焦剑慧; 胡兰英; 张瑜; 李志萍; 单清; 张潇; 杨艳; 袁媛

doi:10.16766/j.cnki.issn.1674-4152.003856

HFEMA结合CATCH模型构建老年患者跌倒安全管理体系效果分析

doi: 10.16766/j.cnki.issn.1674-4152.003856

焦剑慧^{1, 2},
胡兰英^{1, 2},
张瑜²,
李志萍¹,
单清³,
张潇⁴,
杨艳⁵,
袁媛^{1, 2, ,}

1.
扬州大学附属医院护理部，江苏扬州 225001
2.
扬州大学护理学院，江苏扬州 225009
3.
扬州大学附属医院院长办公室
4.
扬州大学附属医院信息处
5.
扬州大学附属医院神经内科

基金项目:

江苏省卫生健康委老年健康科研课题 LK2021054

江苏省医院协会医院管理创新研究课题 JSYGY-3-2021-608

详细信息

通讯作者:
袁媛，E-mail：momsom471@163.com

中图分类号: R473.59
计量
- 文章访问数: 33
- HTML全文浏览量: 17
- PDF下载量: 1
- 被引次数: 0
出版历程
- 收稿日期: 2024-01-04
- 网络出版日期: 2025-02-13

Integrating HFEMA and the CATCH model to develop a fall safety management system for elderly patients

JIAO Jianhui^{1, 2},
HU Lanying^{1, 2},
ZHANG Yu²,
LI Zhiping¹,
SHAN Qing³,
ZHANG Xiao⁴,
YANG Yan⁵,
YUAN Yuan^{1, 2
, ,}

1.
Department of Nursing, Affiliated Hospital of Yangzhou University, Yangzhou, Jiangsu 225001, China

摘要

摘要: 目的探讨医疗失效与效应分析(HFEMA)方法结合CATCH跌倒管理模型构建老年住院患者跌倒管理体系的应用效果。方法以扬州大学附属医院2022年1—12月的老年住院患者36 888例为研究对象，比较HFEMA结合CATCH跌倒管理模型实施前后跌倒发生率、跌倒伤害情况以及护理人员跌倒宣教落实率、老年患者及家属跌倒知识知晓率。结果 HFEMA结合CATCH跌倒管理模型实施后，老年患者跌倒发生率由2022年上半年的0.13%(21/16 696)降至下半年的0.04%(9/20 192)，差异有统计学意义(χ²=7.417，P=0.006)。实施前2、3、4级跌倒伤害例数分别由5例、2例、8例下降至3例、0例、4例(Z=9.828，P＜0.05)。护理人员跌倒宣教落实率由95.1%(15 878/16 696)升至100.0%(20 192/20 192)，老年患者及家属跌倒知识知晓率由85.3%(14 242/16 696)升至92.5%(18 678/20 192)，差异均有统计学意义(P＜0.001)。结论医疗失效模式与效应分析方法、CATCH跌倒管理模型相结合构建出集跌倒评估、预防、干预为一体的老年住院患者跌倒管理体系，有效降低患者跌倒风险，值得推广。
- 医疗失效模式与效应分析 /
- CATCH管理模型 /
- 老年住院患者 /
- 跌倒
Abstract: Objective To explore the effectiveness of combing the healthcare failure mode and effect analysis (HFEMA) with the CATCH fall management model in constructing a fall management system for elderly hospitalized patients. Methods A total of 36 888 elderly patients hospitalized at our hospital from January 2022 to December 2022 were selected as the research objects. The incidence of falls and fall-related injuries, as well as the realization rate of fall education among nursing staff and the awareness rate of fall prevention among elderly patients and their families, were compared before and after the implementation of the HFEMA combined with the CATCH model. Results Following the implementation of the combined HFEMA and CATCH fall management model, the incidence of falls in elderly patients decreased significantly, from 0.13% (21/16 696) in the first half of 2022 to 0.04% (9/20 192) in the second half of 2022 (χ²=7.417, P=0.006). Fall injuries of grade 2, 3, and 4 also decreased from 5, 2, and 8 cases to 3, 0, and 4 cases respectively (Z=9.828, P < 0.05). The compliance rate of nursing staff with fall education increased from 95.1% (15 878/16 696) to 100.0% (20 192/20 192), and the awareness rate of fall prevention among elderly patients and their families increased from 85.3% (14 242/16 696) to 92.5% (18 678/20 192), the differences were statistically significant (P < 0.001). Conclusion The integration of the HFEMA with the CATCH fall management model effectively reduces the risk of falls in elderly hospitalized patients by combining fall assessment, prevention, and intervention. This system is highly effective and recommended for broader implementation.
- Healthcare failure mode and effect analysis /
- Catch fall management model /
- Elderly inpatients /
- Fall

HTML全文

表 1 老年住院患者跌倒失效模式及潜在风险分析

Table 1. Failure mode and potential fall risk analysis in elderly inpatients

流程	潜在失效模式	失效原因	严重度 (S)	发生率 (O)	侦测性 (D)	危急值 (RPN)
评估	未能根据病情随时进行评估	(1)高危因素评估欠全面	8.17	6.17	5.83	293.88
		(2)动态观察不到位	6.33	5.17	3.33	108.98
		(3)再评估意识较差	6.67	3.17	4.17	88.17
告知	告知/宣教不到位，患者/陪护人员对宣教依从性不高	(1)护士配备不完善，环境介绍流于表面	5.33	5.17	4.50	124.00
		(2)无针对性强化宣教	7.00	4.00	3.33	93.24
		(3)宣教内容形式化、不全面	5.33	6.33	5.50	185.56
		(4)宣教效果评价不及时	6.83	5.83	4.33	172.42
		(5)患者未主动寻求帮助	5.50	4.17	5.50	126.14
准备	安全设施不齐全	(1)警示标识设置不合理	4.50	5.50	5.00	123.75
		(2)部分病房卫生间、公共卫生间无扶手	8.50	7.33	5.50	342.68
		(3)夜晚照明不足	6.00	6.83	5.00	177.44
		(4)设施存在安全隐患	5.33	6.33	5.00	174.08
实施	未对有高危风险的跌倒/坠床患者有效交接班或者巡视不到位	(1)安全防范意识不足	5.50	4.67	4.33	111.22
		(2)夜班护士未对高危跌倒/坠床患者重点交班	8.17	7.50	3.17	194.24
		(3)护士人手不足	5.17	6.17	3.67	117.07
观察及记录	未及时发现患者发生跌倒	(1)护士洞察风险能力较差	3.33	3.17	6.50	68.61
		(2)老年住院患者及陪护人员未及时告知护士跌倒的发生	7.00	3.50	3.17	77.67

下载: 导出CSV

表 2 HFEMA结合CATCH跌倒管理模型实施前后老年住院患者发生跌倒情况比较

Table 2. Comparison of falls in elderly hospitalized patients before and after implementing the HFEMA combined with CATCH fall management model

时间	例数	发生跌倒 [例(%)]	跌倒伤害的程度(例)
时间	例数	发生跌倒 [例(%)]	1级	2级	3级	4级
实施前	16 696	21(0.13)	6	5	2	8
实施后	20 192	9(0.04)	2	3	0	4
统计量		7.417^a	9.828^b
P值		0.006	＜0.001
注：^a为χ²值，^b为Z值。

下载: 导出CSV

表 3 HFEMA结合CATCH跌倒管理模型实施前后护理人员跌倒宣教落实、老年患者跌倒知识知晓情况比较[例(%)]

Table 3. Comparison of fall education implementation by nursing staff and fall knowledge awareness in elderly patients before and after implementing the HFEMA combined with CATCH fall management model[cases(%)]

时间	例数	护理人员跌倒宣教有效落实	老年患者跌倒知识知晓情况
实施前	16 696	15 878(95.1)	14 242(85.3)
实施后	20 192	20 192(100.0)	18 678(92.5)
χ²值		1 011.717	493.542
P值		＜0.001	＜0.001

下载: 导出CSV

参考文献(15)

[1]	JAMES S L, LUCCHESI L R, BISIGNANO C, et al. The global burden of falls: global, regional and national estimates of morbidity and mortality from the Global Burden of Disease Study 2017[J]. Inj Prev, 2020, 26(Supp 1): i3-i11. DOI: 10.1136/injuryprev-2019-043286.
[2]	景冬梅, 宋佳牡, 宋薇, 等. 基于FMEA联合PMT护理模式在养老机构老年人安全管理中的应用研究[J]. 实用老年医学, 2022, 36(10): 1067-1070. JING D M, SONG J M, SONG W, et al. Research on the application of FMEA combined with PMT in the safety management of the elderly in nursing home[J]. Practical Geriatrics, 2022, 36(10): 1067-1070.
[3]	徐云佳, 舒碧芸, 郑永韬, 等. 基于竞争风险模型分析超高龄人群跌倒致长期卧床的危险因素及预测模型研究[J]. 中国全科医学, 2024, 27(18): 2192-2197, 2211. doi: 10.12114/j.issn.1007-9572.2023.0757 XU Y J, SHU B Y, ZHENG Y T, et al. Risk Factors and Predictive Model of Long-term Bedridden Risk of Falls in Super-aged Population Based on Competing Risk Model Analysis[J]. Chinese General Practice, 2024, 27(18): 2192-2197, 2211. doi: 10.12114/j.issn.1007-9572.2023.0757
[4]	MIKOS M, BANAS T, CZERW A, et al. Hospital inpatient falls across clinical departments[J]. Inter J Environmen Res Pub Heal, 2021, 18(15): 8167. DOI: 10.3390/ijerph18158167.
[5]	刘明超, 于安山, 钟艳, 等. 基于HFMEA模式构建ICU成人气管插管非计划拔管风险评估量表及信效度检验[J]. 全科护理, 2024, 22(6): 997-1001. LIU M C, YU A S, ZHONG Y, et al. Construction of a risk assessment scale for unplanned extubation of tracheal intubation in ICU adults based on HFMEA model and testing of validity and reliability[J]. Chinese General Practice Nursing, 2024, 22(6): 997-1001.
[6]	龚喜燕, 张翠翠, 钟英, 等. CATCH模型在神经内科住院患者跌倒预防管理中的应用[J]. 现代医药卫生, 2023, 39(1): 141-143, 147. GONG X Y, ZHANG C C, ZHONG Y, et al. Application of CATCH model in fall prevention and management of inpatients in neurology department[J]. Journal of Modern Medicine & Health, 2023, 39(1): 141-143, 147.
[7]	朱圆圆. FMEA理论下优化急救护理流程对急诊颅脑损伤患者急救效率、转运不良事件发生的影响[J]. 临床研究, 2023, 31(3): 148-151. ZHU Y Y. Effect of optimizing Emergency Nursing Process under the FMEA Theory on Emergency Efficiency and adverse Transport Event in Patients with craniocerebral Injury[J]. Clinical Research, 2023, 31(3): 148-151.
[8]	罗园, 邓雨茜, 冉海烨, 等. 养老机构老年人跌倒风险评估的研究进展[J]. 军事护理, 2022, 39(9): 81-84. LUO Y, DENG Y X, RAN H Y, et al. Review on Fall Risk Assessment for Older Adults in Elderly Care Institutions[J]. Military Nursing, 2022, 39(9): 81-84.
[9]	张琪, 刘腊梅. 老年人步态与平衡评估工具研究进展[J]. 中国慢性病预防与控制, 2022, 30(4): 307-311. ZHANG Q, LIU L M. Research progress of gait and balance assessment tools in the elderly[J]. Chinese Journal of Prevention and Control of Chronic Diseases, 2022, 30(4): 307-311.
[10]	陈海莲, 陈曦, 华海平, 等. 老年住院患者跌倒伤害的危险因素研究[J]. 护理与康复, 2020, 19(9): 15-18. CHEN H L, CHEN X, HUA H P, et al. Research on risk factors of fall injury for elderly inpatients[J]. Journal of Nursing and Rehabilitation, 2020, 19(9): 15-18.
[11]	林嘉琪, 吴桂丽, 魏睿宏, 等. 住院患者跌倒不良事件的临床特征研究[J]. 医药高职教育与现代护理, 2021, 4(2): 121-126. LIN J Q, WU G L, WEI R H, et al. Clinical characteristics of falls in inpatients: A retrospective study[J]. Medical Higher Vocational Education and Modern Nursing, 2021, 4(2): 121-126.
[12]	陈红, 张春瑾, 吴波, 等. 医疗失效模式与效应分析在手术室常规病理标本管理中的应用研究[J]. 中国护理管理, 2022, 22(1): 9-13. CHEN H, ZHANG C J, WU B, et al. Application of HFMEA in routine pathological specimens management in the operating room[J]. Chinese Nursing Management, 2022, 22(1): 9-13.
[13]	杨显珠, 徐雪雪, 陈和珍, 等. 6Sigma-DMAIC理念管理法在老年住院患者跌倒风险预防中的应用研究[J]. 中华全科医学, 2022, 20(7): 1182-1185. doi: 10.16766/j.cnki.issn.1674-4152.002553 YANG X Z, XU X X, CHEN H Z, et al. Application of the 6Sigma-DMAIC Concept Management in the prevention of falls of elderly inpatients[J]. Chinese Journal of General Practice, 2022, 20(7): 1182-1185. doi: 10.16766/j.cnki.issn.1674-4152.002553
[14]	高时娟, 言克莉, 夏丽霞. 基于HFMEA模式的静脉化疗安全给药智能模块的设计与应用[J]. 中国临床研究, 2023, 36(2): 316-321. GAO S J, YA K L, XIA L X. Design and application of intelligent module for safe administration of intravenous chemotherapy based on HFMEA mode[J]. Chinese Journal of Clinical Research, 2023, 36(2): 316-321.
[15]	岳跃学, 贾玉玲, 王秀红. 老年人跌倒风险预测模型研究进展[J]. 护理研究, 2022, 36(16): 2944-2948. YUE Y X, JIA Y L, WANG X H. Research progress of fall risk prediction models for the elderly[J]. Chinese Nursing Research, 2022, 36(16): 2944-2948.