急性期脳卒中患者のトイレ動作と転倒の関連について

Abstract

当院医療安全管理委員会の報告では，転倒転落事例における患者の行動目的で最も多いのは排泄行動に起因するものだが，急 性期脳卒中患者のトイレ動作に起因した転倒事例の分析研究は少ない．急性期脳卒中患者のトイレ動作に起因する転倒の特徴 と傾向を明らかにし，症例を通して作業療法士の視点と病棟連携の視点で転倒対策を検討した．トイレ動作に起因して転倒し た急性期脳卒中患者の診療録を後方視的に調査した結果，午後，意識レベルの変動，軽度下肢麻痺，トイレ動作訓練中・歩行 訓練中の 4 項目が転倒の危険因子と考えられた．作業療法士は，転倒リスクのある患者を専門的に評価し，トイレ動作訓練を 重点的に行うことで，病棟連携ではその情報を多職種スタッフと共有，検討することで転倒リスクが軽減されると考えた．

According to the report of the Medical Safety Management Committee at our Hospital, the major cause of fall incidents is related to toilet activities. However, there have been few studies on the fall incidents caused by toilet activities in acute phase brain stroke patients. We examined the characteristics and tendencies related to the fall incidents caused by toilet activities in acute phase brain stroke patients. Then the best measures to prevent falls were considered from the viewpoint of the occupational therapist in collaboration with the ward. Retrospective analysis of the medical charts of the acute phase brain stroke patients who had falls related to the toilet activities revealed 4 risk factors for falls: afternoon, fluctuation in the level of consciousness, mild paralysis of lower limbs, toilet activity training and?walking training. The occupational therapist professionally evaluates the patients with a risk of falling, and focuses on toilet activity training. By sharing the information with the staff in various disciplines, the risk of falls was reduced.