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Kalite İyileştirmeleri Kapsamında Hemodiyaliz Hastalarında Düşme Riskinin Değerlendirilmesi: İki Ölçek Karşılaştırması

Year 2024, Volume: 6 Issue: 2, 103 - 108, 03.08.2024
https://doi.org/10.48071/sbuhemsirelik.1390953

Abstract

Giriş: Hasta düşmeleri, sağlık hizmetlerinde kalitenin en önemli göstergelerinden biridir.
Amaç: Bu çalışmada hemodiyaliz hastalarında düşme riskini değerlendirmek için kullanılan iki aracın
karşılaştırılması amaçlandı.
Yöntem: Hastaların yaş ortalaması 58,72 ± 14,49 yıldı ve %62'si erkekti. Ortalama hemodiyaliz tedavi süresi 4,98 ± 4,71 yıldı. Hastaların %33’ünde son bir yıl içinde düşme öyküsü vardı. Hastaların düşme riski, Itaki Düşme Riski Ölçeği ve Diyaliz Düşme Riski İndeksi kullanılarak değerlendirildi. Hastaların yaşı, cinsiyeti, hemodiyaliz tedavisi süresi ve kronik hastalığa sahip olma durumu ile düşme arasındaki ilişki incelendi.
Bulgular: Itaki skalasına göre %57’si “yüksek riskli” grupta yer almaktadır. Diyaliz Düşme Riski İndeksine göre hastaların %64'ü “çok yüksek risk” grubundaydı. Hastaların ortalama Itaki skoru 4,75 ± 3,92 ve Diyaliz Düşme Riski İndeksi ortalaması 7,59 ± 1,92 idi. Kesme puanına göre Itaki Düşme Riski Ölçeğinin duyarlılığı ve özgüllüğü %97 ve %99,6 iken Diyaliz Düşme Riski Endeksinin ise %93,9 ve %99,6 bulundu. Itaki Düşme Riski Ölçeği için pozitif ve negatif prediktif değerler sırasıyla %56,1 ve %97,7 iken Diyaliz Düşme Riski İndeksi için bu değerler %51,6 ve %100’dü.
Sonuç: Her iki değerlendirme aracının da hemodiyaliz merkezlerinde bakım kalitesini artırmada etkili olduğu bulundu. Bununla beraber kullanım kolaylığı ve hasta uyumu açısından Itaki Düşme Riski Ölçeği tercih edilebilir.

References

  • Abdelhamid, E., Elsaid, S., Khater, M., & Ali, S. (2022). Prevalence offatigue and risk of fall among elderly with chronic kidney disease. The Egyptian Journal of Hospital Medicine, 89(1), 5788-5794. doi: 10.21608/ ejhm.2022.266052
  • Anar, D. (2021). Hemodiyaliz hastalarında düşme riski ve etkileyen etmenler. Çanakkale Onsekiz Mart Üniversitesi Tıp Fakültesi Aile Hekimliği Anabilim Dalı. Uzmanlık Tezi.
  • Barış, V. K., İntepeler, Ş. S., İleri, S. ve Rastgel, H. (2020). İtaki Düşme Riski Ölçeği’nin psikometrik özelliklerinin değerlendirilmesi. Dokuz Eylül Üniversitesi Hemşirelik Fakültesi Elektronik Dergisi, 13(4), 214-221. doi: 10.46483/deuhfed.732097
  • Bello, A. K., Okpechi, I. G., Levin, A., Ye, F., Saad, S., Zaidi, D., …, & Johnson, D. W. (2023). ISN–Global kidney health atlas: A report by the international society of nephrology: An assessment of global kidney health care status focusing on capacity, availability, accessibility, affrdability and outcomes of kidney disease. International Society of Nephrology, Brussels, Belgium. Retrieved date: 28.06.2023. Retrieved from: https://www.theisn.org/wpcontent/uploads/media/ISN%20Atlas_2023%20Digital_REV_2023_10_03. pdf
  • Bowling, C. B., Hall, R. K., Khakharia, A., Franch, H. A., & Plantinga, L. C. (2018). Serious fall injury history and adverse health outcomes after initiating hemodialysis among older U.S. adults. The Journals of Gerontology a Biological Sciences and Medical Sciences, 10;73(9), 1216-1221. doi: 10.1093/gerona/glx260
  • Carvalho, T. C., & Dini, A. P. (2020). Risk of falls in people with chronic kidney disease and related factors. Revista Latino-Americana de Enfermagem, 8(28), e3289. doi: 10.1590/1518-8345.3911.3289
  • Çapar, E. ve Çapar, A. (2018). Yaşlı diyaliz hastalarında geriatrik sorunlar. Geriatrik Bilimler Dergisi, 1 (3), 119-125.
  • Jafari, M., Anwar, S., Kour, K., Sanjoy, S., Goyal, K., & Prasad, B. T. (2021). Scores, FRAX, frailty phenotype, falls, and its relationship to fractures in patients on maintenance hemodialysis. Canadian Journal of Kidney Health and Disease, 24(8), 20543581211041184. doi: 10.1177/20543581211041184
  • Hendrich, A. L., Bender, P. S., & Nyhuis, A. (2003). Validation of the Hendrich II Fall Risk Model: A large concurrent case/control study of hospitalized patients. Applied Nursing Research, 16(1), 9-21. doi: 10.1053/apnr.2003. YAPNR2
  • Karaman, E., Özdemir, Ş. ve Akyol, A. (2020). Hemodiyaliz tedavisi alan hastalarda düşme riskinin belirlenmesi. Nefroloji Hemşireliği Dergisi, 15(3), 217-25. doi: 0.47565/ndthdt.2020.18
  • Kantaş Yılmaz, F., Polat, S., & Bilici, R. (2022). Turkish adaptation of WilsonSims psychiatric fall risk assessment scale. Perspectives in Psychiatric Care, 58(4), 1324-1332. doi: 10.1111/ppc.12934
  • Kono, K., Nishida, Y., Yabe, H., Moriyama, Y., Mori, T., Shiraki, R., & Sato, T. (2018). Development and validation of a Fall Risk Assessment Index for dialysis patients. Clinical and Experimental Nephrology, 22(1), 167-172. doi: 10.1007/s10157-017-1431-8
  • LeLaurin, J. H., & Shorr, R. I. (2019). Preventing falls in hospitalized patients: State of the science. Clinics in Geriatric Medicine, 35(2), 273-283. doi: 10.1016/j.cger.2019.01.007
  • Liu, X., Chen, S., Liu, C., Dang, X., Wei, M., Xin, X., & Gao, J. (2023). Novel risk-factor analysis and risk-evaluation model of falls in patients receiving maintenance hemodialysis. Renal Failure, 45(1), 2182608. doi: 10.1080/0886022X.2023.2182608
  • Matsufuji, S., Shoji, T., Yano, Y., Tamaru, A., Tsuchikura, S., Miyabe, M., Kishimoto, …, & Emoto, M. (2021). Diffculty in activities of daily living and falls in patients undergoing hemodialysis: A cross-sectional study with nondialysis controls. Hemodialysis International, 25, 338 - 347. doi: 10.1111/hdi.12930
  • Montero-Odasso, M., Van Der Velde, N., Alexander, N. B., Becker, C., Blain, H., Camicioli, R., ..., & Task Force on Global Guidelines for Falls in Older Adults. (2021). New horizons in falls prevention and management for older adults: a global initiative. Age and Ageing, 50(5), 1499-1507. doi: 0.1093/ageing/afab076
  • Ministry of Health of Türkiye. (2018). Türkiye böbrek hastalıkları önleme ve kontrol programı (2018-2023). Ankara. Retrieved date: 28.06.2023. Retrieved from: https://hsgm.saglik.gov.tr/depo/birimler/kronik-hastaliklar-engellidb/hastaliklar/bobrek_hastaliklari/kitap_ve_makaleler/Turkiye_Bobrek_ Hastaliklari_Onleme_ve_Kontrol_Programi_2018-2023.pdf
  • Ministry of Health of Türkiye. (2020). Kronik Böbrek Hastalığı Klinik Protokolu. T.C. Sağlık Bakanlığı Yayın Numarası: 1180. Retrieved date: 28.06.2023. Retrieved from: https://dosyamerkez.saglik.gov.tr/Eklenti/38987,kronikbobrekhastaligikpyayin-verspdf.pdf?0
  • Tezcan, B. ve Karabacak, B. G. (2021). Klinik uygulamada sık kullanılan düşme riski tanılama ölçekleri. Journal of Academic Research in Nursing, 7(2), 105-112. doi: 10.55646/jaren.2021.88598
  • Turkish Society of Nephrology. (2020). Türkiye’de nefroloji, diyaliz ve transplantasyon. T.C. Sağlık Bakanlığı ve Türk Nefroloji Derneği ortak raporu. Ankara; 2020. Retrieved date: 18.06.2023. Retrieved from: https:// nefroloji.org.tr/uploads/folders/file/REGISTRY_2020.pdf
  • Van Loon, I. N., Joosten, H., Iyasere, O., Johansson, L., Hamaker, M. E., & Brown, E. A. (2019). The prevalence and impact of falls in elderly dialysis patients: Frail elderly Patient Outcomes on Dialysis (FEPOD) study. Archives of Gerontology and Geriatrics, 83, 285-291. doi: 10.1016/j.archger.2019.05.015
  • Zanotto, T., Mercer, T. H., Linden, M. L. V., Traynor, J.P., Doyle, A., Chalmers, K., …, & Koufaki, P. (2020). Association of postural balance and falls in adult patients receiving haemodialysis: A prospective cohort study. Gait & Posture, 82, 110-117. doi: 10.1016/j.gaitpost.2020.08.128
  • Zhao, Y., Liu, Q., & Ji, J. (2020). The prevalence of frailty in patients on hemodialysis: a systematic review and meta-analysis. International Urology and Nephrology, 52(1), 115-120. doi: 10.1007/s11255-019-02310-2

Evaluation of Fall Risk in Hemodialysis Patients within the Scope of Quality Improvements: A Comparison of Two Assessment Scales

Year 2024, Volume: 6 Issue: 2, 103 - 108, 03.08.2024
https://doi.org/10.48071/sbuhemsirelik.1390953

Abstract

Introduction: Patient falls are one of the most important quality indicators in healthcare.
Aim: It was aimed to compare two tools used to evaluate fall risk in hemodialysis patients.
Method: The mean age of the patients was 58.72 ± 14.49 years and 62% were male. The mean duration of treatment was 4.98 ± 4.71 years. Within the last year, 33% of the patients had a history of falling. The patients' fall risk was assessed using the Itaki Fall Risk Scale and Dialysis Fall Risk Index. The relationship between patients' age, gender, duration of hemodialysis treatment, and the status of having a chronic disease and falls were examined.
Results: According to the Itaki Scale, 57% were in the ''high-risk'' group. According to the Dialysis Fall Risk Index, 64% were in the "very high risk" group. The mean Itaki Fall Risk Scale score was 4.75 ± 3.92, and the mean of the Dialysis Fall Risk Index was 7.59 ± 1.92. According to the cut-of score, the sensitivity and specifiity of the Itaki Fall Risk Scale were 97% and 99.6%, and the Dialysis Fall Risk Index was 93.9% and 99.6%. The positive and negative predictive value were 56.1% and 97.7%, respectively for the Itaki Fall Risk Scale. These points were 51.6% and 100% for the Dialysis Fall Risk Index.
Conclusion: Both scales were effctive in improving care quality in hemodialysis centers. Itaki Scale may be preferred due to its ease of use and patient compliance.

Ethical Statement

Istanbul Medipol University Non-Invasive Clinical Research Ethics Committee Date and No:01/07/2021 ve E-10840098-772.02-3152

Supporting Institution

None.

Thanks

I thank all healthcare staff working for the dialysis center where data is collected.

References

  • Abdelhamid, E., Elsaid, S., Khater, M., & Ali, S. (2022). Prevalence offatigue and risk of fall among elderly with chronic kidney disease. The Egyptian Journal of Hospital Medicine, 89(1), 5788-5794. doi: 10.21608/ ejhm.2022.266052
  • Anar, D. (2021). Hemodiyaliz hastalarında düşme riski ve etkileyen etmenler. Çanakkale Onsekiz Mart Üniversitesi Tıp Fakültesi Aile Hekimliği Anabilim Dalı. Uzmanlık Tezi.
  • Barış, V. K., İntepeler, Ş. S., İleri, S. ve Rastgel, H. (2020). İtaki Düşme Riski Ölçeği’nin psikometrik özelliklerinin değerlendirilmesi. Dokuz Eylül Üniversitesi Hemşirelik Fakültesi Elektronik Dergisi, 13(4), 214-221. doi: 10.46483/deuhfed.732097
  • Bello, A. K., Okpechi, I. G., Levin, A., Ye, F., Saad, S., Zaidi, D., …, & Johnson, D. W. (2023). ISN–Global kidney health atlas: A report by the international society of nephrology: An assessment of global kidney health care status focusing on capacity, availability, accessibility, affrdability and outcomes of kidney disease. International Society of Nephrology, Brussels, Belgium. Retrieved date: 28.06.2023. Retrieved from: https://www.theisn.org/wpcontent/uploads/media/ISN%20Atlas_2023%20Digital_REV_2023_10_03. pdf
  • Bowling, C. B., Hall, R. K., Khakharia, A., Franch, H. A., & Plantinga, L. C. (2018). Serious fall injury history and adverse health outcomes after initiating hemodialysis among older U.S. adults. The Journals of Gerontology a Biological Sciences and Medical Sciences, 10;73(9), 1216-1221. doi: 10.1093/gerona/glx260
  • Carvalho, T. C., & Dini, A. P. (2020). Risk of falls in people with chronic kidney disease and related factors. Revista Latino-Americana de Enfermagem, 8(28), e3289. doi: 10.1590/1518-8345.3911.3289
  • Çapar, E. ve Çapar, A. (2018). Yaşlı diyaliz hastalarında geriatrik sorunlar. Geriatrik Bilimler Dergisi, 1 (3), 119-125.
  • Jafari, M., Anwar, S., Kour, K., Sanjoy, S., Goyal, K., & Prasad, B. T. (2021). Scores, FRAX, frailty phenotype, falls, and its relationship to fractures in patients on maintenance hemodialysis. Canadian Journal of Kidney Health and Disease, 24(8), 20543581211041184. doi: 10.1177/20543581211041184
  • Hendrich, A. L., Bender, P. S., & Nyhuis, A. (2003). Validation of the Hendrich II Fall Risk Model: A large concurrent case/control study of hospitalized patients. Applied Nursing Research, 16(1), 9-21. doi: 10.1053/apnr.2003. YAPNR2
  • Karaman, E., Özdemir, Ş. ve Akyol, A. (2020). Hemodiyaliz tedavisi alan hastalarda düşme riskinin belirlenmesi. Nefroloji Hemşireliği Dergisi, 15(3), 217-25. doi: 0.47565/ndthdt.2020.18
  • Kantaş Yılmaz, F., Polat, S., & Bilici, R. (2022). Turkish adaptation of WilsonSims psychiatric fall risk assessment scale. Perspectives in Psychiatric Care, 58(4), 1324-1332. doi: 10.1111/ppc.12934
  • Kono, K., Nishida, Y., Yabe, H., Moriyama, Y., Mori, T., Shiraki, R., & Sato, T. (2018). Development and validation of a Fall Risk Assessment Index for dialysis patients. Clinical and Experimental Nephrology, 22(1), 167-172. doi: 10.1007/s10157-017-1431-8
  • LeLaurin, J. H., & Shorr, R. I. (2019). Preventing falls in hospitalized patients: State of the science. Clinics in Geriatric Medicine, 35(2), 273-283. doi: 10.1016/j.cger.2019.01.007
  • Liu, X., Chen, S., Liu, C., Dang, X., Wei, M., Xin, X., & Gao, J. (2023). Novel risk-factor analysis and risk-evaluation model of falls in patients receiving maintenance hemodialysis. Renal Failure, 45(1), 2182608. doi: 10.1080/0886022X.2023.2182608
  • Matsufuji, S., Shoji, T., Yano, Y., Tamaru, A., Tsuchikura, S., Miyabe, M., Kishimoto, …, & Emoto, M. (2021). Diffculty in activities of daily living and falls in patients undergoing hemodialysis: A cross-sectional study with nondialysis controls. Hemodialysis International, 25, 338 - 347. doi: 10.1111/hdi.12930
  • Montero-Odasso, M., Van Der Velde, N., Alexander, N. B., Becker, C., Blain, H., Camicioli, R., ..., & Task Force on Global Guidelines for Falls in Older Adults. (2021). New horizons in falls prevention and management for older adults: a global initiative. Age and Ageing, 50(5), 1499-1507. doi: 0.1093/ageing/afab076
  • Ministry of Health of Türkiye. (2018). Türkiye böbrek hastalıkları önleme ve kontrol programı (2018-2023). Ankara. Retrieved date: 28.06.2023. Retrieved from: https://hsgm.saglik.gov.tr/depo/birimler/kronik-hastaliklar-engellidb/hastaliklar/bobrek_hastaliklari/kitap_ve_makaleler/Turkiye_Bobrek_ Hastaliklari_Onleme_ve_Kontrol_Programi_2018-2023.pdf
  • Ministry of Health of Türkiye. (2020). Kronik Böbrek Hastalığı Klinik Protokolu. T.C. Sağlık Bakanlığı Yayın Numarası: 1180. Retrieved date: 28.06.2023. Retrieved from: https://dosyamerkez.saglik.gov.tr/Eklenti/38987,kronikbobrekhastaligikpyayin-verspdf.pdf?0
  • Tezcan, B. ve Karabacak, B. G. (2021). Klinik uygulamada sık kullanılan düşme riski tanılama ölçekleri. Journal of Academic Research in Nursing, 7(2), 105-112. doi: 10.55646/jaren.2021.88598
  • Turkish Society of Nephrology. (2020). Türkiye’de nefroloji, diyaliz ve transplantasyon. T.C. Sağlık Bakanlığı ve Türk Nefroloji Derneği ortak raporu. Ankara; 2020. Retrieved date: 18.06.2023. Retrieved from: https:// nefroloji.org.tr/uploads/folders/file/REGISTRY_2020.pdf
  • Van Loon, I. N., Joosten, H., Iyasere, O., Johansson, L., Hamaker, M. E., & Brown, E. A. (2019). The prevalence and impact of falls in elderly dialysis patients: Frail elderly Patient Outcomes on Dialysis (FEPOD) study. Archives of Gerontology and Geriatrics, 83, 285-291. doi: 10.1016/j.archger.2019.05.015
  • Zanotto, T., Mercer, T. H., Linden, M. L. V., Traynor, J.P., Doyle, A., Chalmers, K., …, & Koufaki, P. (2020). Association of postural balance and falls in adult patients receiving haemodialysis: A prospective cohort study. Gait & Posture, 82, 110-117. doi: 10.1016/j.gaitpost.2020.08.128
  • Zhao, Y., Liu, Q., & Ji, J. (2020). The prevalence of frailty in patients on hemodialysis: a systematic review and meta-analysis. International Urology and Nephrology, 52(1), 115-120. doi: 10.1007/s11255-019-02310-2
There are 23 citations in total.

Details

Primary Language English
Subjects ​Internal Diseases Nursing​
Journal Section Araştırma Makaleleri
Authors

Özden Güdük 0000-0002-2268-0428

Early Pub Date July 30, 2024
Publication Date August 3, 2024
Submission Date November 15, 2023
Acceptance Date April 21, 2024
Published in Issue Year 2024 Volume: 6 Issue: 2

Cite

APA Güdük, Ö. (2024). Evaluation of Fall Risk in Hemodialysis Patients within the Scope of Quality Improvements: A Comparison of Two Assessment Scales. Sağlık Bilimleri Üniversitesi Hemşirelik Dergisi, 6(2), 103-108. https://doi.org/10.48071/sbuhemsirelik.1390953
AMA Güdük Ö. Evaluation of Fall Risk in Hemodialysis Patients within the Scope of Quality Improvements: A Comparison of Two Assessment Scales. UHSJN. August 2024;6(2):103-108. doi:10.48071/sbuhemsirelik.1390953
Chicago Güdük, Özden. “Evaluation of Fall Risk in Hemodialysis Patients Within the Scope of Quality Improvements: A Comparison of Two Assessment Scales”. Sağlık Bilimleri Üniversitesi Hemşirelik Dergisi 6, no. 2 (August 2024): 103-8. https://doi.org/10.48071/sbuhemsirelik.1390953.
EndNote Güdük Ö (August 1, 2024) Evaluation of Fall Risk in Hemodialysis Patients within the Scope of Quality Improvements: A Comparison of Two Assessment Scales. Sağlık Bilimleri Üniversitesi Hemşirelik Dergisi 6 2 103–108.
IEEE Ö. Güdük, “Evaluation of Fall Risk in Hemodialysis Patients within the Scope of Quality Improvements: A Comparison of Two Assessment Scales”, UHSJN, vol. 6, no. 2, pp. 103–108, 2024, doi: 10.48071/sbuhemsirelik.1390953.
ISNAD Güdük, Özden. “Evaluation of Fall Risk in Hemodialysis Patients Within the Scope of Quality Improvements: A Comparison of Two Assessment Scales”. Sağlık Bilimleri Üniversitesi Hemşirelik Dergisi 6/2 (August 2024), 103-108. https://doi.org/10.48071/sbuhemsirelik.1390953.
JAMA Güdük Ö. Evaluation of Fall Risk in Hemodialysis Patients within the Scope of Quality Improvements: A Comparison of Two Assessment Scales. UHSJN. 2024;6:103–108.
MLA Güdük, Özden. “Evaluation of Fall Risk in Hemodialysis Patients Within the Scope of Quality Improvements: A Comparison of Two Assessment Scales”. Sağlık Bilimleri Üniversitesi Hemşirelik Dergisi, vol. 6, no. 2, 2024, pp. 103-8, doi:10.48071/sbuhemsirelik.1390953.
Vancouver Güdük Ö. Evaluation of Fall Risk in Hemodialysis Patients within the Scope of Quality Improvements: A Comparison of Two Assessment Scales. UHSJN. 2024;6(2):103-8.

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