1 materials and methods from March 2004 to March 2005, the department of cardiology in our hospital accidentally fell 1 1 case, with an average age of 72.4 years. There were 4 males and 7 females. All suffer from cardiovascular diseases. Among them, hypertension is 1 case; Dilated cardiomyopathy complicated with heart failure in 3 cases; There were 7 cases of coronary heart disease and 4 cases of diabetes. 1 case of rheumatic heart disease complicated with heart failure. There were 2 cases of cerebral hemorrhage, 2 cases of scalp trauma, 2 cases of lumbar compression fracture, femoral neck fracture 1 case, and the rest were soft tissue contusion. Triggered three medical conflicts. In view of this phenomenon, our department set up a fall prevention quality action team in May 2005 [2] to formulate practical nursing intervention measures for inpatients over 65 years old, and the quality team regularly evaluates and checks the implementation of fall prevention countermeasures. The causes of falls of patients in cardiology department were analyzed.
2 Analysis of the causes of falls
2. 1 The average age of patients in this group was 72.4 years old. The physiological characteristics of the elderly are the decline of physiological functions of various systems, degenerative changes of joints, dysfunction of sensory balance, slow response and unstable gait, which easily leads to unstable posture and falls. Osteoporosis caused by aging is an important risk factor for injuries and disabilities caused by falls in the elderly [3].
2.2 Transient cerebral hypoxia and transient ischemic attack can affect cerebral blood supply and cause intermittent dizziness. The elderly suddenly stand up from the lying or sitting position, causing dizziness, dizziness, blurred vision and so on. Because the brain is temporarily short of blood supply, it is easy to stand unsteadily and fall down.
2.3 Patients with severe arrhythmia all have different degrees of cardiovascular diseases, often complicated with various serious arrhythmias. Such as bradyarrhythmia (sinus arrest, ⅲ AVB); Tachyarrhythmia (ventricular tachycardia, ventricular fibrillation, ventricular flutter, supraventricular tachycardia), etc. Causes hemodynamic changes, Asperger's syndrome attacks and falls.
2.4 side effects of drugs After taking antihypertensive drugs, hypertensive patients often have postural hypotension due to rapid changes in posture; Patients with heart failure take diuretics for a long time, urinate more at night, get up frequently, and electrolyte disorders, such as low potassium, low sodium and low chlorine, are the risk factors for falls. Patients with coronary heart disease are also prone to fall down after taking vasodilators. Taking sleeping pills is also one of the factors of falling.
2.5 Psychological factors Due to the aging of the social population and social factors, the elderly are unwilling to become the burden of their children, overestimate their mobility, and are unwilling to be accompanied by their families during hospitalization, which is also one of the reasons why the elderly fall.
2.6 Environmental factors The ability of the elderly to cope with emergencies is poor, and the role played by environmental factors is particularly important. If the environment is dirty, there are obstacles in the ward, the ground is slippery and there is water; Insufficient light at night; There are no handrails in the bathroom, bathroom and corridor; A bed without guardrails; In addition, because the bed is too small and too high, the patient is short, it is inconvenient to get on and off the bed, and it is difficult to sit on the bed steadily; These environmental factors cooperate with their own factors, which increases the risk of falling.
3 Exploration of the safe path of falling In view of the above reasons, our department set up a fall prevention quality action group composed of head nurses and head nurses to carry out feedforward control on nursing safety management and set up the contents of safe handover. And introduce the concept of clinical pathway into autumn nursing, open up a safe nursing path, focus on educating high-risk groups, strictly control high-risk links, remember the warnings in high-risk periods, and enhance high-risk awareness. Evaluate and analyze the risk factors of patients entering the safe path every week, and give specific guidance until the patients leave the hospital. And wholeheartedly create a department nursing safety culture, regularly hold nursing safety education and training, carry out nursing safety knowledge competitions, and post safety warnings in wards, corridors, toilets and other places. In the department, everyone attaches great importance to nursing safety. Specific measures include: detailed assessment of whether there is a history of falls before admission, whether there are diseases that are easy to cause falls in this illness or past medical history, the patient's vision, whether there is a potential fall crisis when taking medicine at or before admission, gait and balance ability, whether there is serious arrhythmia and water and electricity balance. For patients with high risk of falling, they should enter the nursing safety path and change shifts every day. Nurses in hospital beds should introduce the ward environment and dangerous places that are easy to fall, such as toilets, bathrooms and stairs. To attract the attention of patients and guide them to wear non-slip shoes. For patients with high risk of falling, it is necessary to issue doctor's advice, issue escort cards and ask their families to accompany them. For family members who cannot accompany them for various reasons, they should explain the illness in detail and sign it as evidence to avoid medical disputes. Those who take antihypertensive drugs, vasodilators, cerebral blood supply insufficiency and stay in bed for a long time should assist the patients to urinate in bed, do a good job in health education, and avoid changing their positions too quickly. Family members or nurses should assist them to prevent postural hypotension. In addition to observing the urine volume, patients who use diuretics should also pay attention to the electrolyte level and supplement potassium, sodium, chlorine and magnesium in time. For patients with severe arrhythmia, they should be placed in the intensive care unit and stay in bed absolutely. After the condition is stable, they should get out of bed to strengthen the shift change. Take all necessary safety measures to eliminate adverse environmental factors. Nurses in sickbeds guide patients to familiarize themselves with the ward and surrounding environment, and bathrooms and corridors should have sufficient lighting and handrails. When the middle shift nurses turn off the lights, they will add a bed bar to each patient, turn on the floor lamp, and persuade the elderly patients with heart failure to go to the toilet at night, minimize the use of diuretics at night, and reduce the number of getting up at night. You can ring the bell to inform the nurse when you get up at night and ask the nurse to help. The ground should be kept flat and dry. If the ground has just been wiped, there should be a striking sign "Pay attention to the slippery road to prevent falling" to remind the elderly to pay attention to anti-skid. The bed height of the elderly is 55 cm [4].
Results From May 2005 to May 2006, there were 4 cases of falls in one year, with a decrease of 63.6%, since the quality action group for preventing falls was established in our department and the nursing safety path was opened up. Among them, 2 cases were TIA, 1 case occurred when going to the toilet, and 1 case was sudden ventricular tachycardia. It can be seen that taking effective intervention measures can effectively reduce the incidence of falls. Therefore, a very important task of fall nursing in cardiology department is to effectively evaluate and actively eliminate various risk factors that lead to falls. Only through comprehensive and meticulous nursing evaluation, nursing intervention when necessary and the joint efforts of nurses, the elderly and their families can we effectively prevent falls and ensure the health and quality of life of the elderly.