Résumé
Objective:To investigate the application status of the practice evidence of falls prevention in elderly inpatients in Chinese comprehensive tertiary hospitals.Methods:Using a self-designed questionnaire based on the practice evidence of falls prevention in elderly inpatients to investigate the application status of that in 81 Chinese comprehensive tertiary hospitals.Results:93.83% (76/81) of the investigated hospitals had a falls screen in the admission assessment of elderly inpatients, and 49.38% (40/81) of the surveyed hospitals used Morse Falls Scale to screen. At the same time, 62.96%(51/81) of the hospitals had falls assessment of elderly inpatients, while only 25.93%-40.74% of the hospitals included the fear of falls, urinary incontinence, footwear, as well as foot problems in the falls screen or assessment. In addition, the implementation rate of falls prevention was 12.35%-79.01% in the hospitals surveyed, and only 60.49% (49/81) of the hospitals had individualized falls prevention intervention. Furthermore, the falls prevention participation rate of primary nurses and doctors, as well as patients′ care was higher than 80.00%, but that of pharmacists, rehabilitation therapists and physiotherapists was only between 12.35% to 24.69%.Conclusions:Hospitals should take the characteristics of environment and elderly inpatients in the hospital into consideration to choose the risk factors which should be included in the falls screen/assessment, as well as select the appropriate screen/assessment tools. Meanwhile, hospitals should culture and encourage the right workers′ participation to build a multidisciplinary team for falls assessment and intervention to achieve the goal of falls and falls injuries prevention with the evidence.
Résumé
EBM is the integration of best research evidence with clinical expertise and patient values. EBM has been extending to “evidence-based healthcare/practice” with wider perspectives. When considering healthcare-related evidence, it is useful to distinguish three aspects. Namely, they are “create”, “communicate”and “utilize”. At first, “clinical questions” are generated in real clinical settings. To create clinical evidence, “clinical questions” need to be refined as “research questions”. Concerning the aspect of communication, there are lots of proposals and statements to improve the reporting of research findings. The Uniform Requirements for Manuscripts Submitted to Biomedical Journals proposed by the International Committee of Medical Journal Editors has been evolved since 1979 and has become the global standard for scientific authors and editors. Concerning the aspect of “utilize”, there are two problems, that is, overuse and underuse of evidence. The former is related with the problem of evidence-practice gap. Appropriate use of clinical practice guidelines are expected to reduce these gaps. The latter is linked with the confusion that evidence equals EBM. Evidence is merely evidence even if the level is high in scientific and general meaning. When clinicians make individual decisions, they are required to do them comprehensively balancing the three factors such as evidence, value and resource.