| Objective:Through the retrospective analysis of the fall of hospitalized cancer patients,the risk factors of falls and fall injury were investigated in order to explore the causes of the patients' falls and the characteristics of the patients who were injured after the falling,to provide evidence-based basis to screening cancer patients with high-risk of falling.The purpose of our study is to take the appropriate nursing intervention for decreasing the incidence of falling and protecting the hospitalized cancer patients from fall injury and to improve the quality of nursing.Methods:The convenient sampling method was used to retrieve the fallen patients reported in the medical malpractice reporting system of hospital information system(HIS)from March 2010 to July 2016 in a tertiary hospital specialist hospital.A total of 142 cases of falls were retrieved.According to the hospital number,the patient's information is retrieved in the hospital medical record system,including the patient's gender,age,diagnosis,merger disease,treatment,time of fall,place and time of hospitalization,medication status,blood analysis within 3 days before and after falls,self-care ability and the degree of injury.Statistical analyzed by SPSS 22.0,the general information is described by frequency and percentage,and the risk factors of fall injury are analyzed by chi-square and logistic regression.Two sets of comparison difference have statistical significance(P<0.05)Results:1.The general information of hospitalized cancer patientsAmong all fall patients,the incidence of falling is higher than others during the patients who are males,the age group of 61-70 years,percentage of functional status score(Karnofsky,KPS,card)score of 90 points,and had a history of abnormal blood pressure,cerebrovascular disease or chemotherapy,and had cancer distant metastasis or respiratory cancer.Falling was more likely happened at noon to 6 p.m.and there were 74 cases with no injury after falling,accounting for 52.1%,56 cases of first degree injury,accounting for 39.4%,6 cases of two degree injury,accounting for 4.25%,6 cases of three degree injury,accounting for 4.25%.2.Differences in general information and clinical data of injury after fallingIn the 81 male patients who had fallen,43 had fall injury,accounting for 53.1%.Of the 61 female patients,25 happened fall injury,accounting for 41%(P>0.05).No significance was found between males and females..Among the 75 patients who were older than 60 years of age,40 of them had fall injury,accounting for 53.3%.Whereas 28 of the 67 patients younger than 60 had fall injury,accounting for 41.8%(P<0.05).Among the 81 patients who were able to move autonomously,37 had fall injury(44%),whereas 28 of the 53 patients who had partial dependency had fall injury of 52.5%,and 5 patients who were completely dependent,3 cases had fallen injury,accounting for 60%(P<0.05),these results suggest self-care ability is related to fall injury in hospital.The injury rate of patients with high risk score of falling was 47.7%,P>0.05,the difference was not statistically significant.Among 25 patients who had previous cerebrovascular disease,17 had fall injury(68%)and for patients who have no previous cerebrovascular disease,the incidence of fall is 43.6%(P<0.01),which suggest that patients who had a history of previous cerebrovascular disease are easily falling in hospital.For patients with abnormal blood pressure,the incidence of fall is 81.6%,whereas the incidence of falls is 35.6%(P<0.05)in patients with normal blood pressure,which suggest the patients with abnormal blood pressure is more vulnerable to fall injury.Among the 80 patients with distant cancer metastasis,the incidence of falling is 53.8%,whereas 40.3%in patients with no cancer metastasis(P<0.05),which suggest that the patients with cancer metastasis were more likely to hurt after falling.Among the cancer patients with multiple metastasis the injury rate was 61%,and the injury rate was 42.6%among the patients without multiple metastasis,P<0.05.The difference was significant.The patients with multiple metastasis of cancer are more prone to hurt after falling.In the 38 patients who had bone metastases in falls,the incidence of fall is 55.2%,whereas 45.2%in patients without bone metastases(P<0.05),which hints that patients with bone metastases are more likely to hurt.Based on the analysis of the injury rate of brain metastasis,the injury rate is 45.5%,the rate is 48.3%among patients without brain metastasis,P<0.05,the difference was not statistically significant.The injury rate of cancer patients with liver metastasis is 58.8%,contrast to 46.4%without liver metastasis,P>0.05,the difference was not statistically significant.In addition,the incidence of fall in patients with chemotherapy alone,radiotherapy and chemotherapy or radiotherapy alone,is 39.7%,80%and 38.5%(P<0.05),respectively,which hints that the patients with concurrent radiotherapy and chemotherapy are more likely to hurt.The injury rates of patients with chemotherapy such as Cisplatin,Docetaxel,Paclitaxel Liposome,Gemcitabine are 37.5%,50%,50%,62.5%,P>0.05 with Chi-square test,the difference was not statistically significant.In the 19 patients with chemotherapy who had used drugs such as sedation,analgesic and diuretic drugs,the incidence of fall is 52.6%,whereas 47.2%in nocombination with such above-mentioned drugs(P<0.05),which hints the patients who was treated with sedatives,painkillers or diuretics the patient are more likely to hurt after falling.Among the 87 patients with abnormal blood indexes,the incidence of fall is 58.6%,whereas 30.9%is in patients with normal blood indexes(P<0.01),which suggest that the patients with abnormal blood indexes is more prone to hurt.The incidence of fall is 50%,41.3%,54.5%and 48.5%in 6:01-12:00,12:01-18:00,18:01-24:00 and 0:01-6:00,respectively(P>0.05).The difference was not significant.The incidence of fall is 50%,42.5%,45%,57.1%and 87.5%is in the toilet,the ward,the corridor,the yard and outside of yard,respectively(P>0.05),and the difference is not significant.3.Logistic regression analysis for the risk factors of fall injuryOur investigation has taken many risk factors into account,including age,blood pressure,abnormal hemogram,treatment,cancer metastasis,self-care,previous cerebrovascular disease.The experimental values were Logistic regressed using the Logistic model as follows:Logit(p)= 0.542 x1 +0.465 x2 +1.153 x3-0.538.Logistic regression analysis showed that the regression coefficients of cancer metastasis,age and blood samples were 1.099,0.339 and 0.445,respectively,and their P values were 0.003,0.005 and 0.030,respectively.Conclusion1.Those groups of patients had more times of falling who are male,aged 61 to 70,had the disease of respiratory system cancers.cerebrovascular disease history,abnormal blood pressure,distant metastasis of cancer,chemotherapy and radiotherapy and chemotherapy.And the falls happened more at the places of rest room and ward and time during 12:01-18:00.The patients without injuries took a large proportion and the number of first degree injury was much more than those of second and third degree injury.2.The incidence of falling injury is higher in the patients,who are over 60 years,KPS 90,,fall score high risk,had self-care ability and had a history of abnormal blood pressure,cerebrovascular disease or chemotherapy,and had cancer distant metastasis and multiple metastasis,bone metastasis or respiratory cancer,combine treatment with sedation,diuretic,analgesic drugs and have abnormal blood indexes.Whereas the factors such as sex,the time of the fall,falling of high risk,chemotherapy and the location are no related to falling injury.3.Logistic regression analysis suggested that older patients and those with more abnormal blood indexes or have distant metastasis of cancer were more likely to suffer injuries after falling.Specifically,when the other two variables are the same,the risk of falls injury was 59.1%higher in people over 60 years of age than others(OR=1.591),patients with abnormal hemogram were more than two times more likely to hurt after falling than those with normal hemogram(OR=3.167),and the incidence of injury in patients with cancer metastasis was 72%higher than that in patients without metastasis(OR=1.720). |
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