Üçüncü Basamak Bir Rehabilitasyon Merkezinden 3 Yıllık Düşme Verilerinin Kök Neden Analizi

Öz

Düşmeler, yaşlı bireyler, aileleri ve sağlık sistemleri üzerinde ciddi sonuçlara yol açan, giderek büyüyen bir halk sağlığı sorunudur. Bu çalışmanın amacı, üçüncü basamak bir rehabilitasyon merkezinde meydana gelen düşmelerin köken nedenlerini ve risk faktörlerini belirlemek ve düşmeye bağlı hastane yatış sürelerini azaltmaya yönelik stratejiler önermektir. Bu retrospektif, kesitsel araştırmaya, üçüncü basamak bir rehabilitasyon merkezinde yatarak tedavi görmekte iken düşme olayı bildirilen 248 hasta dahil edilmiştir. Hastaların demografik ve klinik özellikleri; cinsiyet, yaş, tanı, hastanede yatış sürecinde düşmenin meydana geldiği gün, kronik hastalık öyküsü, polifarmasi durumu, düşmenin gerçekleştiği yer ve zaman ile başvuru anındaki vitamin D, total (25 OH) ve albümin düzeyleri kaydedilerek analiz edilmiştir. Çalışmada düşme insidansı %1,8 olup, hastaların medyan yaşı 56’dır. Düşmeler en sık inme (%23), omurilik yaralanması (%18,5) ve pediatrik rehabilitasyon (%17,7) kliniklerinde gözlenmiştir. Olayların çoğunluğu hasta odalarında (%47,6), banyolarda (%25) ve klinik koridorlarında (%14,9) meydana gelmiş; en sık 08:00–16:00 saatleri arasında (%48) gerçekleşmiştir. Erişkin hastalarda düşme riski yaş ile anlamlı pozitif korelasyon göstermiştir (r=0,338, p<0,001). Ayrıca komorbid hastalığı bulunan (p=0,011) veya polifarmasi öyküsü olan (p<0,011) bireylerde düşme riskinin anlamlı düzeyde yüksek olduğu saptanmıştır. Pediatrik grupta düşme risk skoru albumin düzeyi ile negatif (r=-0,472, p=0,048) korelasyon gösterdi. Düşmelerin, özellikle kompleks tıbbi duruma sahip orta yaşlı hemiplejik ve paraplejik hastalarda daha sık görüldüğü belirlenmiştir. Yüksek riskli hastaların yatış sırasında erken dönemde tanımlanması ve düzenli aralıklarla risk değerlendirmesinin tekrarlanması, etkili düşme önleme programlarının uygulanması açısından kritik öneme sahiptir.

Anahtar Kelimeler

• Itaki Düşme Riski Ölçeği
• Düşmeler
• Rehabilitasyon Merkezi
• Kök Neden Analizi
• Düşme Önleme

Root Cause Analysis of 3-year Falls Data From a Tertiary Rehabilitation Center

Öz

Falls are a growing public health issue with severe impacts on older adults, their families, and healthcare systems. This study aims to identify the root causes and risk factors of falls in a tertiary rehabilitation center and suggest measures to reduce fall-related hospital stays. This retrospective, cross-sectional study included 248 patients who were reported to have fallen among the patients receiving inpatient rehabilitation at a tertiary rehabilitation center. Demographic and clinical characteristics such as gender, age, diagnosis, day of fall in the rehabilitation hospital, history of chronic disease, polypharmacy, place of fall, time of fall, vitamin D, total (25 OH) levels and albumin levels at the time of admission were recorded. The fall rate was 1.8%, with a median patient age of 56. Falls were most common in stroke (23%), spinal cord injury (18.5%), and pediatric rehabilitation (17.7%) clinics, mainly occurring in patient rooms (47.6%), bathrooms (25%), and clinic corridors (14.9%), typically between 8:00 and 16:00 (48%). In adults, fall risk increased with age (r=0.338, p<0.001) and was higher in those with comorbidities (p=0.011) or polypharmacy (p<0.011). In pediatric group, fall risk score was negatively correlated with albumin level (r=-0.472, p=0.048). Falls were most common among middle-aged hemiplegia and paraplegia patients with complex medical conditions. Identifying high srisk patients at admission and conducting regular assessments are key to effective fall prevention.

Anahtar Kelimeler

• Itaki Fall Risk Scale
• Falls
• Rehabilitation Center
• Root Cause Analysis
• Fall Prevention

Kaynakça

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