回復期リハビリテーション病棟での転倒予防実践—活動性アップと重大事故防止両立への実践，臨床倫理の観点も含めて

Preventing Patient Falls in Convalescent Rehabilitation Wards : Concurrent Action on Activity Improvement and Prevention of Serious Accidents with an Approach from the Perspective of Clinical Ethics

はじめに

　回復期リハビリテーション（以下，リハ）病棟協会が行った全国調査（2007年9月，回復期リハ病院対象，有効回答数201病院）によれば，医療安全上の問題（複数回答）であるとされたのは「転倒」（182病院）が最も多く，次に「離院」（85），「誤嚥」（76），「誤薬」（65），「急変時対応」（55），「認知暴力」（37），「クレーム」（31），「感染」（28），「事故訴訟」（8），「危機管理（大規模災害）」（8），「セクハラ」（5）であった．回復期リハ病棟にて最も重要とされる転倒について当協会での「転倒事故」を減少させていくための取り組みを紹介する．

Abstract : Falls account for the highest number of medical safety incidents in convalescent rehabilitation wards, followed in declining order by unauthorized absences, misdeglutition, medication errors, etc. In a nationwide survey on patient falling incidents (2,653 samples), 14.1％ of the patients experienced falls, of which roughly half fell twice or more. The length of time from hospitalization to the first fall was under one week for 24.6％. Medical issues recognized as relevant to fall incidents were paralysis, previous falls, consciousness disturbance, delirium, depression, use of psychotropic drugs, visual impairment, sensory disturbance, urinary incontinence, pain, apraxia, unilateral spatial neglect, attention disturbance, mode of locomotion and cognitive impairment. To address this problem, it is necessary to implement measures aimed at identifying high-risk patients at an early stage and prevent patient behavior that may lead to falling, measures aimed at detecting and responding swiftly to actions that may lead to falling in order to prevent such incidents, and measures aimed at mitigating damage, etc., in such an incident. A multidisciplinary team representing various job functions should confer regularly to implement necessary measures. Additionally, such measures should be explained to the patient and the patient's family at an early stage, paying due respect to clinical ethics regarding physical constraint. Finally, a basic flow of action should be defined regarding the response to and reporting of falling incidents.