减少患有癌症和血液疾病的住院儿童和青少年跌倒:质量改进之旅。

IF 1.2 Q3 PEDIATRICS
Pediatric quality & safety Pub Date : 2024-08-30 eCollection Date: 2024-09-01 DOI:10.1097/pq9.0000000000000755
Lisa K Morrissey, Phuc Ho, Maya Ilowite, David A Johnson, Colleen M Nixon, Marissa K Thomas, Julie A Waitt, Amy Wierzchowski, Ashley M Renaud
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引用次数: 0

摘要

背景:儿科住院病人跌倒是一个严重的患者安全问题。患有癌症和血液疾病的儿童和青少年有一些固有的危险因素,增加了跌倒受伤的可能性。波士顿儿童医院的血液学/肿瘤学(HO)和干细胞移植(SCT)住院部开始了为期多年的质量改进之旅,以减少住院病人跌倒的发生:一个有针对性的减少跌倒工作组在 2020 年至 2023 年期间实施了多项关键举措。这些措施包括:加强沟通策略,提高对高跌倒风险患者的认识;对每次跌倒致伤事件进行正式的明显原因分析;以及启动一项以理疗为主导的计划,以减少体能下降。衡量结果的指标包括跌倒总数、每 1000 个患者日中可预防的跌倒受伤率以及可预防的跌倒受伤间隔天数。我们的质量改进团队使用统计过程控制图来跟踪随时间发生的变化:每 1000 个患者日的可预防跌倒受伤率从 2020 财年的 0.63 降至 2023 财年的 0.25。2021-2023年,SCT和HO病房的可预防跌倒受伤间隔时间分别达到442天和410天,而2020年分别为124天和117天。这两个单位在 4 年内的跌倒总数减少了 51%:一项多方面的减少跌倒质量倡议有效地减少了儿科HO和SCT住院病房可预防的跌倒致伤事件,从而减少了弱势患者群体中可避免的伤害。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Reducing Falls in Hospitalized Children and Adolescents with Cancer and Blood Disorders: A Quality Improvement Journey.

Background: Falls in hospitalized pediatric patients represent a serious patient safety concern. Children and adolescents with cancer and blood disorders have inherent risk factors that increase the likelihood of injury from falls. The Hematology/Oncology (HO) and Stem Cell Transplant (SCT) inpatient units at Boston Children's Hospital embarked on a multiyear quality improvement journey to reduce inpatient falls in this population.

Methods: A targeted Falls Reduction Task Force implemented key initiatives between 2020 and 2023. These include enhancing communication strategies to heighten awareness of the highest fall-risk patients, conducting a formal apparent cause analysis on every fall with injury, and initiating a physical therapy-led program to reduce deconditioning. Outcome measures were total falls, rate of preventable falls with injury per 1000 patient days, and days between preventable falls with injury. Our quality improvement team used statistical process control charts to track changes over time.

Results: The combined rate of preventable falls with injury per 1000 patient days decreased from 0.63 in fiscal year (FY) 2020 to 0.25 in 2023. The SCT and HO units achieved a maximum of 442 days and 410 days, respectively, between preventable falls with injury in 2021-2023, compared with 124 and 117 days in 2020. The two units observed a 51% reduction in total falls over 4 years.

Conclusions: A multifaceted fall reduction quality initiative effectively reduced preventable falls with injury on pediatric HO and SCT inpatient units, thereby reducing avoidable harm in a vulnerable patient population.

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