血液内科患者の転倒・転落についての分析と取り組み

Abstract

2017 年4 月から2 年間，部署安全マネージャーとして血液内科患者の転倒・転落減少の取り組みを行った．2017 年1 年間の 血液内科患者の転倒31 件についてカルテとインシデントレポートから，①年齢，②意識レベル，③血液データ，④治療内容な どの情報を収集し，転倒の要因分析を行った．結果，若年層で意識レベルが清明な状態での転倒が多かった．また，転倒した 時期は化学療法の血球減少期が多く，全ての患者が貧血の状態であるという身体的特徴が明らかになった．このことから患者 が疾患や治療に伴う身体的変化を理解し，自らが転倒・転落に注意して行動できる習慣を身につけることが重要であると考え， 患者参加型の転倒予防対策として転倒防止カレンダーを使用した．さらに転倒した患者に対し多職種カンファレンスを行い，患者の病状や歩行状態などを多職種で評価し，患者に個別的な転 倒予防策の重要性を改めて認識できた．今回明らかになった患者の転倒要因や特徴を生かし，患者参加型の転倒予防の取り組みを強化することの必要性が示唆され たため報告する．

For 2 years since 2017, I have been conducting studies to lower the incidence of falls by hematology patients. From the incident report of 31 hematology patients who had falls during the year of 2017, information on the patient including ① age, ② consciousness level, ③ hematology data, and ④ treatment information were collected to analyze the factors causing the falls. As a result, most of the younger patients had falls while they had normal consciousness levels. The time of the fall in most patients coincided with the time when the patient’s blood cell count was decreasing due to chemotherapy. The systemic condition showed that all of the patients were suffering from anemia. These results suggest that the patient needs to understand the change in his/her condition caused by the illness and treatment; and to adjust their behavior taking precautions to prevent falls. Then, a fall prevention calendar was made to help each patient participate in the prevention of falls. The state of the illness and walking condition were evaluated by holding a multidisciplinary conference for the patient sustaining a fall, and the importance of preventive measures specifically designed for each patient was confirmed. Here I report the need to enforce preventive measures with the participation of the patient taking into consideration the cause of the falls and characteristics identified in this study.