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Literatureresearchjournal.pdf
Sakai AM, Rossaneis MÂ, Haddad MCFL et al. Risk of bed falls in adult patients and...
English/Portuguese
J Nurs UFPE on line., Recife, 10(11):4720-6, Nov., 2016 4720
ISSN: 1981-8963 ISSN: 1981-8963 DOI: 10.5205/reuol.8200-71830-3-SM.1006sup201602
RISK OF BED FALLS IN ADULT PATIENTS AND PREVENTION MEASURES RISCO DE QUEDA DO LEITO DE PACIENTES ADULTOS E MEDIDAS DE PREVENÇÃO RIESGO DE CAÍDAS DE LA CAMA EN PACIENTES ADULTOS Y MEDIDAS DE PREVENCIÓN
Andressa Midori Sakai 1 , Mariana Ângela Rossaneis
2 , Maria do Carmo Fernandez Lourenço Haddad
3 , Dagmar
Willamowius Vituri 4
ABSTRACT
Objective: to analyze the adequacy between the evaluation of the risk in adult patients´ fall and the prevention measures adopted. Method: this is a descriptive, cross-sectional study with a quantitative approach. The sample consisted of 1,408 patients from a public university hospital. Data were collected through the application of the Morse Scale and evaluation of bed fall prevention measures. The data were tabulated in the Microsoft Office Excel 2010 program and for statistical analysis the SPSS Program version 2.1 was used. Descriptive analyzes and chi-square test were performed, considering a p-value <0.05. Results: patients older than 60 years old had a higher risk of falls (33.9%). The individuals classified as having high risk were those who were connected to venous devices (90.1%), those with a previous history of falling (59.9%) and with a disoriented state of mind (34.0%). The prevention measures were adequate in 91.0%. Conclusion: knowing the risks of falling and the quality indicators, associated with the awareness and training of professionals are essential measures in the prevention of incidents and adverse events. Descriptors:
Accidents by Falls; Nursing Care; Patient Safety.
RESUMO
Objetivo: analisar a adequação entre avaliação de risco de queda de pacientes adultos e as medidas de prevenção adotadas. Método: estudo descritivo, transversal, de abordagem quantitativa. A amostra foi composta por 1.408 pacientes de um hospital universitário público. A coleta de dados ocorreu por meio da aplicação da Escala de Morse e avaliação das medidas de prevenção de queda do leito. Os dados foram tabulados no programa Microsoft Office Excel 2010 e para análise estatística utilizou-se o Programa SPSS versão 2.1. Foram realizadas análises descritivas e aplicação do teste Qui-Quadrado, considerando um p- valor<0,05. Resultados: pacientes com idade superior a 60 anos apresentaram maior risco de queda (33,9%). Os indivíduos classificados com alto risco foram os que estavam conectados a dispositivos venosos (90,1%), os que apresentaram histórico de queda anterior (59,9%) e com estado mental desorientado (34,0%). As medidas de prevenção estavam adequadas em 91,0%. Conclusão: conhecer os riscos de queda e os indicadores de qualidades, associado com a sensibilização e capacitação dos profissionais, são medidas imprescindíveis na prevenção de incidentes e eventos adversos. Descritores: Acidentes por Quedas; Cuidados de Enfermagem;
Segurança do Paciente.
RESUMEN
Objetivo: analizar la adecuación entre evaluación de riesgo de caída de pacientes adultos y las medidas de prevención adoptadas. Método: estudio descriptivo, transversal, de enfoque cuantitativo. La muestra fue compuesta por 1.408 pacientes de un hospital universitario público. La recolección de datos fue por medio de la aplicación de la Escala de Morse y evaluación de las medidas de prevención de caídas de la cama. Los datos fueron tabulados en el programa Microsoft Office Excel 2010 y para análisis estadística se utilizó el Programa SPSS versión 2.1. Fueron realizadas análisis descriptivas y aplicación del test Chi-Cuadrado, considerando un p-valor<0,05. Resultados: pacientes con edad superior a 60 años presentaron mayor riesgo de caída (33,9%). Los individuos clasificados con alto riesgo fueron los que estaban conectados a dispositivos venosos (90,1%), los que presentaron histórico de caídas anteriores (59,9%) y con estado mental desorientado (34,0%). las medidas de prevención estaban adecuadas en 91,0%. Conclusión: conocer los riesgos de caídas y los indicadores de calidades, asociado con la sensibilización y capacitación de los profesionales, son medidas imprescindibles en la prevención de incidentes y eventos adversos. Descriptores: Accidentes por Caídas;
Cuidados de Enfermería; Seguridad del Paciente. 1 Nurse, Resident of Nursing Services Management, State University of Londrina/UEL. Londrina (PR), Brazil. E-mail:
[email protected]; 2 Nurse, Master´s Professor, Ph.D. student, State University of Londrina/UEL. Londrina (PR), Brazil. E-mail:
[email protected]; 3 Nurse, Ph.D. Professor, Master's Program in Nursing, State University of Londrina/ UEL. Londrina (PR),
Brazil. E-mail: [email protected]; 4 Nurse, Ph.D., Nursing Care Quality Control Assistance, University Hospital of Londrina, State
University of Londrina/UEL. Londrina (PR), Brazil. E-mail: [email protected]
ORIGINAL ARTICLE
Sakai AM, Rossaneis MÂ, Haddad MCFL et al. Risk of bed falls in adult patients and...
English/Portuguese
J Nurs UFPE on line., Recife, 10(11):4720-6, Nov., 2016 4721
ISSN: 1981-8963 ISSN: 1981-8963 DOI: 10.5205/reuol.8200-71830-3-SM.1006sup201602
Patient falls in the hospital environment
are a major problem for health organizations
worldwide, since the repercussions of this
event on the health of the individual can
result in an increase in hospitalization time,
worsening of the clinical picture and even
death 1,2
as well as emotional and social
consequences. 3 This is an incident that has
mobilized researchers in the search for
instruments that can assess patients at
increased risk, with the aim of establishing
preventive measures to mitigate it. 1
The World Health Organization (WHO)
defines the fall as an event that inadvertently
leads the individual to the ground or a lower
level. It is estimated that 391,000 people died
in 2002 because of falls, making it the second
leading cause of death resulting from
unintentional injury after traffic accidents. 4
The WHO points out that at the global
level, adults over 70 years old and especially
women, have a significantly higher mortality
rate related to falls than younger adults.
However, children under 15 years have more
morbidity. 4
Falling is an unexpected, usually
unintentional, traumatic, multifactorial, and
often recurrent event in the same individual
and the associated risk factors can be
classified as intrinsic and extrinsic. 1-3
As intrinsic factors, there are the changes
in the physical, biological and psychological
functioning of the individual, the appearance
of chronic and musculoskeletal disorders,
altered the balance, vision, and hearing
related to age, which predisposes the person
to situations of greater fragility. Extrinsic
factors are associated with the environment,
such as inadequate lighting, slippery floors,
lack of adaptations in toilets and uneven
surfaces. 1-2
Given the repercussions for the quality of
life of the patient, the problem of falls in the
hospital environment has been researched
worldwide. 5 A study developed in a Brazilian
university hospital identified the occurrence
of tissue injuries of different intensities,
orthopedic traumas characterized as bruises
and fractures, as well as consequences that
caused changes in the physical and mental
state of the patients, as well as loss of
consciousness. 6
Besides the consequences of this event for
the health of the patient, they still contribute
to the increase of hospital costs, since the fall
can increase the costs of hospitalization by
61% due to the average increase in the time of
permanence in 12, 3 days and the treatment
of the damages resulting from this incident. 7
Because of the consequences of patients´
healthy lifestyles, falling prevention has been
treated as a matter of priority in health
institutions 2 and it is part of the global patient
safety movement that began in the 1990s and
culminated, in Brazil, with the publication of
the Ministerial Ordinances and Resolutions of
the Collegiate Board of Directors (RDC) in
2013 which determine the adoption of a policy
focused on patient safety by health
institutions as well as protocols for Related to
the Six International Goals of Patient Safety,
one of them being the Prevention of Falls,
which is an indicator of quality of care. 8
Ordinance Nº 2,095, dated September 24,
2013, which approved the basic protocols for
patient safety, with the Protocol for the
Prevention of Falls determines the need to
evaluate all patients regarding the risks of
falls, followed by the elaboration and
prescription of preventive measures according
to the risk of each. 9
The adoption of instruments that allow an
assessment of the risk factors for falls is the
first step in the establishment of strategies for
the prevention of this adverse event. 10
Several
validated scales for the assessment of falls
risk exist in the scientific literature, one of
them being the Morse scale, which was
developed in 1985 by Janice Morse, Canada,
to identify and predict the risk of falls in
adults using six items of assessment. It is a
widely used international scale because it is
easy to develop. 10
Given the importance of preventing falls in
hospitalized patients and the challenge based
on evidence-based data, overcoming cultural
and infrastructure barriers to create an
environment that promotes patient safety,
the importance of the development of this
study is characterized.
● To analyze the adequacy between the
evaluation of the risk of falls in adult patients
and the prevention measures adopted.
This is a descriptive, cross-sectional study
with a quantitative approach at a public
university hospital in the Northern region of
the State of Paraná, PR, Brazil. It is a tertiary
education institution, with 313 beds
exclusively intended to assist patients of the
Unified Health System-SUS.
The study sample consisted of 1,408
patients, aged more or equal to 18 years old,
admitted to medical and surgical units,
Emergency Room (ER) and Intensive Care Unit
(ICU).
INTRODUCTION
METHOD
OBJECTIVE
Sakai AM, Rossaneis MÂ, Haddad MCFL et al. Risk of bed falls in adult patients and...
English/Portuguese
J Nurs UFPE on line., Recife, 10(11):4720-6, Nov., 2016 4722
ISSN: 1981-8963 ISSN: 1981-8963 DOI: 10.5205/reuol.8200-71830-3-SM.1006sup201602
The data are part of an information
database of the nursing audit service of the
hospital under study and refer to the period
from April 2012 to June 2013. The collection
was performed through an operational audit
to evaluate 15 quality indicators with the
“Risk of Fall” indicator that is determined by
the application of the Morse scale. 11
The Morse Scale determines the risk of falls
by evaluating six criteria: a history of falls in
the last three months, secondary diagnoses,
mobilization assistance, connectivity in
venous infusion devices, gait, and mental
status. The scale score varies from zero to >
45 points, with 0 to 24 points corresponding to
a low risk of falling, 25 to 44 points means
moderate risk and ≥45 points have a high risk
of falling. 12
It should be pointed out that, among the
preventive measures of fall, this study is
limited to evaluate the lateral protection grid
of the bed, which must be continually
elevated in patients with a Morse score equal
or greater than 45 and the continuous
presence of one caregiver with the patient
who has a high-risk score for fall. 11,12
The data were tabulated in the program
Microsoft Office Excel 2010, and for statistical
analysis the program SPSS version 2.1 was
used. Descriptive analyses and chi-square test
were performed, considering a p-value <0.05.
Regarding ethical precepts, this research
was authorized by the institution´s
management, in compliance with Resolution
466/12, which refers to studies involving
human beings, and it was approved by the
Research Ethics Committee of the State
University of Londrina, CAAE 0224.0.268.000-
11.
In this study, there were 1,408 patients
evaluated for the risk of falls, of which 63.3%
were hospitalized in the medical-surgical
units, 26.8% in the ER and 9.9% in the ICUs.
The high risk of falling score was more
prevalent in the medical-surgical units
(21.6%).
Table 1 shows the characteristics of the
sample regarding the gender and age of the
patients classified with a Morse score greater
than 45 - high risk for fall.
Table 1. Association of the variable gender and age with the Morse Score for high risk of falls in adult patients of a Public University Hospital, Londrina- PR, 2014.
Variable Total % High risk P<0 RP CI
Gender Total % Female 686 48.7 134 19.5 0.94 1 - Male 722 51.3 160 22.2 - 0.99 0.87 – 1.13 Age Younger thann 60 years old
930 66.1 169 18.2 0.00 1 -
Older than 60 years old
478 33.9 125 26.2 1.31 1.15 – 1.50
As for gender, 51.3% of the study
participants are men, with 22.2% at high risk
for falls.
Also, 33.9% of the patients were over 60
years old and had 26.2% higher prevalence of
high risk for falls when compared to younger
patients (CI:1.15-1.50). Also, 64.8% of patients
classified as being at high risk for falls and
over 60 years old are males.
Regarding the evaluation criteria used by
the Morse Scale, the most prevalent items in
the individuals classified as high risk for falls
were: connection to the venous infusion
equipment (90.1%); history of previous falls
(59.9%) and disoriented mental state (34.0%).
It should be noted that 31.3% of patients
with some associated underlying disease,
38.8% presented a high risk for falls.
Regarding the percentage of the adequacy
of the prevention measures adopted, 91.0% of
the patients with the Morse Scale score for
high-risk falls had the necessary measures
adopted, as observed in Table 2.
RESULTS
Sakai AM, Rossaneis MÂ, Haddad MCFL et al. Risk of bed falls in adult patients and...
English/Portuguese
J Nurs UFPE on line., Recife, 10(11):4720-6, Nov., 2016 4723
ISSN: 1981-8963 ISSN: 1981-8963 DOI: 10.5205/reuol.8200-71830-3-SM.1006sup201602
Table 2. Prevalence of conformity among prevention measures in patients classified as high risk for falls in a Public University Hospital, Londrina- PR, 2014.
Conformity of prevention measures
Gender
Male Female Total
n % n % N %
Adequate 150 56.0 118 44.0 268 91.0 Inadequate 10 39.0 16 61.0 26 9.0 Total 193 65.6 99 33.7 294 20.9
In Table 2, when comparing the prevention
measures to gender, it is possible to observe
that 61.1% of the female patients had
inadequate prevention measures.
Most of the evaluated patients were in
medical and surgical hospitalization units
(63.3%) since they represent most of the beds
of the studied institution. Of these patients,
21.6% were classified as high risk for fall,
corroborating with the findings of another
study carried out in the South of Brazil, where
58% of the 53 recorded falls occurred in
clinical hospitalization units. 6
Similar data were also identified in a study
carried out in the state of São Paulo, in a
public hospital, in which 321 falls of
hospitalized patients were recorded. Of them,
58.9% occurred in clinical hospitalization units
and 19.2% in surgical hospitalization units. 13
These results suggest that the high risk of falls
in surgical hospitalization units may be
related to the change in the Brazilian age
pyramid associated with the prevalence of
chronic diseases since the profile of patients
hospitalized in these places is for the elderly
who depend on a range of medicines and have
reduced mobility. 13
Regarding the age group, the findings of
this study reiterate the results of other
studies, 2,6,13-4
that demonstrate that patients
over 60 years old are at higher risk of falls.
This fact may be related to the intrinsic
factors, such as the reduction of functional
capacity, 1 associated with extrinsic factors,
related to the inadequacy of the environment,
which increase the risk for falls, such as
inadequate furniture, slippery floors, high
beds, etc. 1- 3,6
It is emphasized that the adaptation to the
hospital environment for many elderly people
becomes difficult because mental and
cognitive decline damages them in recognition
of the environment and can result in mental
confusion and agitation, which are associated
with greater risk of falls. 4
A study carried out in a Portuguese
university hospital showed that most of the
falls occurred in patients who were confused
and agitated, 2 which was also evidenced in
this study, since most patients at high risk for
falls had a disoriented state of mind (34.0%).
As in other studies, 6 the gender variable
cannot be statistically associated with a
higher risk of falls. However, in this study,
high risk was more prevalent among men
(51.3%). In a survey carried out in a hospital in
Lisbon-Portugal, 214 episodes of falls were
identified, 63% of which occurred in men. It
was also evidenced that they suffered three
times more recurrent falls than women. 15
The
fact that men presented greater fall incidence
can be explained by the cultural factor of
non-acceptance of assistance in certain
necessities of daily life, such as getting up
from bed 6 or walking.
Another related fact to the greater risk for
fall was the use of venous devices (90.1%) and
the presence of associated clinical
comorbidities (31.3%). Similar results were
found in a study carried out with adult
patients of clinical and surgical units of a
university hospital in the South of Brazil, in
which the use of venous devices was
emphasized in 54.3% and associated
pathologies in 53.8% of the patients with a
high risk of falling. 16
In another study conducted in Cuiabá/MT,
53.1% of the falls were in individuals who
presented some comorbidity, especially
hypertension. Chronic diseases may involve
osteoarticular and sensitivity complications,
requiring the use of one or more drugs. 22
The
use of medications, whether or not related to
comorbidities, is responsible for the increased
risk of falls, especially when there is an
association of four or more drugs and/or use
of psychoactive drugs. 15
Also, a high prevalence of patients with a
previous history of falls was identified
(59.9%). In a study carried out in São Paulo,
SP, most patients of the 321 falls presented
only one episode of this adverse event.
However, it was pointed out that 10% suffered
two falls and in 1.8% the patients suffered
three falls in the same hospitalization period,
especially in the first days of hospitalization. 13
The presence of more than one fall may be
related to anxiety about the new condition
the patient is, as well as the use of new
medications and non-adaptation to the
hospital environment. 13
It can also lead to
depression, insecurity, and fear of a new fall. 9
Regarding the prevention of fall, 9.0% of
the patients evaluated at high risk for this
adverse event were not adequately safe,
DISCUSSION
Sakai AM, Rossaneis MÂ, Haddad MCFL et al. Risk of bed falls in adult patients and...
English/Portuguese
J Nurs UFPE on line., Recife, 10(11):4720-6, Nov., 2016 4724
ISSN: 1981-8963 ISSN: 1981-8963 DOI: 10.5205/reuol.8200-71830-3-SM.1006sup201602
among them, the majority were women. This
finding suggests that the active search
strategy for falls, adopted by the institution
under study, is effective for the control of this
event, as it detects the risk before the
occurrence of the incident, alerting the nurses
of the assistance units to the need of measure
implementation. However, it is important to
emphasize that, even for patients classified as
low and medium risk of falls, standard
precautionary measures should be adopted by
adapting the space as a way to guarantee a
safe care environment. 9
In daily practice, it is observed that health
teams are usually focused on the clinical and
therapeutic conditions of patients, forgetting
the environmental conditions as decisive
factors for safety, especially regarding the
prevention of falls in the hospital
environment, event with potential for
recovery of their patients. 17
There is DRC 50 of February 21, 2002 to
reinforce the importance of the environment
for patient safety,, which approves the
Technical Regulation for planning,
programming, elaborating, evaluating and
approving physical projects of care
institutions of health 18
, and the Brazilian
Regulatory Standard - NBR 9050/2004 of the
Brazilian Association of Technical Standards,
which draws attention to accessibility in
buildings, furniture, spaces and urban
equipment. 19
A study performed in a large hospital in the
city of Curitiba-PR evaluated 127 beds of
hospitalization units and identified
inadequacy about environmental safety
standards in 77.7%. These non-conformities
were related to the non-coating of the floors
with non-slip material, elevators are not
signaled as “Risk of Falls, ” and the path
traveled by the patient was not free of
obstacles, and 66.6% of the sanitary facilities
did not meet technical standards. 20
Regarding the devices that reduce the risk
of falls, about the side protection grids of the
litter/bed, a publication analyzed 80 episodes
of falls and found that 55% of the falls from
the bed occurred due to the non-elevation of
the lateral grid of the bed. 14
However, it is
important the presence of a caregiver with
the patient when maintaining the side rails
elevated, especially for elderly patients to
ensure that this elderly person does not want
to leave the bed alone, passing over the
protection grids. 20
In this sense, the elevation of the lateral
bed rails can result in a decrease in the
number of falls, besides the importance of
adopting complementary measures related to
the extinction of the environmental risks, such
as excessive conversations or noise,
illumination not adequate, beds in low
position, at a suitable height, between 100%
and 120% of the patient´s lower leg length. 2
However, the adoption of preventive
measures will not work without the awareness
and training of professionals and the
construction of systematic and monitorable
prevention protocols. 3
The hospital scenario of this research
initiated the movement for the
implementation of the fall prevention
protocol, as well as the other protocols
related to patient safety, in 2011. However,
to function effectively, it is essential that, in
the event of this incident, there is
notification 4 to the bodies responsible for
research and development of plans for the
prevention of adverse events. Underreporting
is still a reality in the institution under study,
but awareness measures have been adopted to
minimize this problem.
It is expected that the fear of reporting an
adverse event will be replaced by the search
for and analysis of the facts that contributed
to such injury since errors should not be based
on people but process failures. 21
From the results of this study, it was
concluded that the active search for patients
at risk for falls is an effective strategy for the
prevention of this adverse event. In this
sense, the importance of the adoption of
health institutions of quality indicators in the
pursuit of care security, to providing a better
understanding of the processes, detection of
fragilities and directing corrective measures
necessary for the promotion of safe care.
Also, it is imperative that health professionals
be sensitized and trained to prevent adverse
events, especially falls, which can result in
irreversible damages to patients, families, and
society.
As a limitation of this study, there is the
fact of not analyzing the fall events occurred
in the institution, which is justified by their
underreporting.
1. PinhoTAM de, Silva AO, Tura LFR, Moreira
MASP, Gurgel SN, Smith AAF et al. Assessing
the risk of falls for the elderly in Basic Health
Units. Rev Esc Enferm USP [Internet] 2012
[cited 2015 Jan 17];46(2):320-7. Available
from
http://www.scielo.br/scielo.php?script=sci_ar
ttext&pid=S0080-
62342012000200008&lng=en&nrm=iso. Doi
http://dx.doi.org/10.1590/S0080-
62342012000200008.
REFERENCES
CONCLUSION
Sakai AM, Rossaneis MÂ, Haddad MCFL et al. Risk of bed falls in adult patients and...
English/Portuguese
J Nurs UFPE on line., Recife, 10(11):4720-6, Nov., 2016 4725
ISSN: 1981-8963 ISSN: 1981-8963 DOI: 10.5205/reuol.8200-71830-3-SM.1006sup201602
2. Abreu C, Mendes A, Monteiro J, Santos
FR. Falls in hospital settings: a longitudinal
study. Rev Lat Am Enfermagem (Online)
[Internet]. 2012 [cited 2015 Mar
19];20(3):597-603. Available from:
http://www.scielo.br/scielo.php?script=sci_ar
ttext&pid=S0104-
11692012000300023&lng=en&nrm=iso. DOI:
http://dx.doi. org/10.1590/S0104-
11692012000300023.
3. Almeida RAR, Abreu CCF, Mendes AMOC.
Quedas em doentes hospitalizados:
contributos para uma prática baseada na
prevenção. Rev Enf Ref [Internet]. 2010 [cited
2015 Mar 19];3(2):2163-72. Available from:
http://www.scielo.mec.pt/pdf/ref/vserIIIn2/
serIIIn2a17.pdf
4. World Health Organization. Who global
report on falls prevention in older age. World
Health Organization [Internet]. France: OMS;
2007 [cited 2014 Mar 19]. Available from:
http://www.who.int/violence
_injury_prevention/other _injury/falls/en/.
5. Jorgensen J. Reducing patient falls: A call
to action. In: Special Supplement to American
Nurse Today - Best Practices for Falls
Reduction: A Practical Guide [Internet]. 2011
[cited 2015 Mar 19]; 6(2): 6-7. Available from:
http://www.americannursetoday.com/special
-supplement-to-american-nurse-today-best-
practices-for-falls-reduction-a-practical-
guide-2/
6. Costa SGRF, Monteiro DR, Hemesath MP,
Almeida MA. Caracterização das quedas do
leito sofridas por pacientes internados em um
hospital universitário. Rev Gaúcha Enferm
[Internet]. 2011 [citado 2013 Mar
19];32(4):676-81. Available from:
http://www.scielo.br/pdf/rgenf/v32n4/
v32n4a06.pdf
7. Kulik C. Components of a comprehensive
fall risk assessment. In: Special Supplement to
American Nurse Today - Best Practices for
Falls Reduction: A Practical Guide [Internet].
2012 [cited 2015 Mar 19];6(2):6-7. Available
from:
http://www.americannursetoday.com/Art
icle. aspx?id=7634&fid=7364.
8. Brasil. Ministério da Saúde. Portaria Nº
2.095, de 24 de Setembro de 2013. Aprova os
Protocolos Básicos de Segurança do Paciente
[cited 2015 Jan 17] Available from:
http://bvsms.saude.gov.br/bvs/
saudelegis/gm/2013/prt2095_24_09_2013.htm
l
9. Ministério da Saúde (BR), Agência
Nacional de Vigilância Sanitária, Fiocruz.
Programa Nacional de Segurança do Paciente.
Protocolo Prevenção de Quedas [Internet]. Rio
de Janeiro: ANVISA; 2013. [cited 2015 Jan 18].
Available from: http://por-
talsaude.saude.gov.br/portalsaude/arquivos/
pdf/2013/Mai/06/protocolos_ CP_n6_2013.Pdf
10. Costa-Dias MJ, Ferreira PL. Fall risk
assessment tools. Referência [Internet]. 2014
[cited 2015 Mar 20];4(2):153-61. Available
from:
http://www.uc.pt/feuc/pedrof/Investigacao/
Art_Rev . doi: 10.12707/RIII12145
11. Vituri DW, Matsuda LM. Content validation
of quality indicators for nursing care
evaluation. Rev Esc Enferm USP [Internet].
2009 [cited 2015 Jan 9];43(2):429-37.
Available
from:http://www.scielo.br/pdf/reeusp/v43n2
/en_a24v43n2.pdf
12. Morse J. Preventing patient falls. Thosand
Oaks: Sage; 1997.
13. Laus AM, Meneguetti MG, Santos JA, Rosa
PDP. Perfil das quedas em pacientes
hospitalizados. Cienc Cuid Saude [Internet].
2014 [cited 2015 Jan 9];13(4):688-695,
http://www.periodicos.uem.br/ojs/index.php
/CiencCuidSaude/article/view/19234
14. Paiva MCMS, Paiva SAR, Berti HW,
Campana AO. Caracterização das quedas de
pacientes segundo notificação em boletins de
eventos adversos. Rev Esc Enferm USP
[Internet]. 2010 [cited 2015 Jan 9]; 44(1):134-
138. Available from:
http://www.scielo.br/pdf/reeusp/v44n1/a19v
44n1.pdf
15. Costa-Dias MJM, Oliveira AS, Moreira CN,
Santos AS, Martins T, Araújo F. Quedas dos
doentes internados em serviços hospitalares,
associação com os grupos terapêuticos. Rev
Enf Ref [Internet]. 2013 [cited 2015 Jan
9];9(3):105-114. Available from:
http://www.scielo.mec.pt/scielo.php?script=s
ci_arttext&pid=S0874-
02832013000100011&lng=pt.
http://dx.doi.org/10.12707/RIII12142
16. Rocha HB, et al. Avaliação do risco de
quedas em adultos hospitalizados. Rev
Graduação. [Internet]. 2013 [cited 2015 Jan
9];6(1):[about 5 p}. Available from:
http://revistaseletronicas.pucrs.br/ojs/index.
php/graduacao/article/view/13763/9289
17. Correa AD, Marques IAB, Martinez MC,
Laurino PS, Leão ER, Chimentão DMN.
Implantação de um protocolo para
gerenciamento de quedas em hospital:
resultados de quatro anos de seguimento. Rev
Esc Enferm USP [Internet]. 2012 [cited 2015
Jan 9];46(1):67-74.
http://www.scielo.br/pdf/reeusp/v46n1/v46n
1a09.pdf
Sakai AM, Rossaneis MÂ, Haddad MCFL et al. Risk of bed falls in adult patients and...
English/Portuguese
J Nurs UFPE on line., Recife, 10(11):4720-6, Nov., 2016 4726
ISSN: 1981-8963 ISSN: 1981-8963 DOI: 10.5205/reuol.8200-71830-3-SM.1006sup201602
18. Brasil. Agencia Nacional de Vigilância
Sanitária. RDC 50 de 22 de fevereiro de 2002.
Aprova o Regulamento Técnico destinado ao
planejamento, programação, elaboração,
avaliação e aprovação de projetos físicos de
estabelecimentos assistenciais de saúde
[Internet]. 2002. Available from:
http://portal.anvisa.gov.br/wps/wcm/connec
t/ca36b200474597459fc8df3fbc4c6735/RDC+N
%C2%BA.+50,+DE+21+DE+FEVEREIRO+DE+2002.
pdf?MOD=AJPERES
19. Associação Brasileira de Normas Técnicas.
NBR 9050/2004. Acessibilidade a edificações,
mobiliário, espaços e equipamentos urbanos
[Internet]. Rio de Janeiro: ANVISA, 2004 [cited
2015 Mar 19]. Available from:
http://pfdc.pgr.mpf.mp.br/ atuacao-e-
conteudos-de-apoio/legislacao/ pessoa-
deficiencia/norma-abnt-NBR-9050/view
20. Vaccari E, Lenardt MH, Willig MH, Betiolli
SE, Oliveira ES. Safety of the hospital
environment in terms of preventing falls on
the part of the elderly: a descriptive study.
Online braz j nurs [Internet] 2014 [cited 2015
Mar 18];13(3):271-81. Available from:
http://www.objnursing.uff.br/index.php/nurs
ing/article/view/4753
21. Quinto NA. Segurança dos pacientes,
profissionais e organizações: um novo padrão
de assistência à saúde. Rev Adm Saúde
[Internet] 2006 [cited 10 Apr 2015].8(33): 153-
158. Available from:
http://www.nascecme.com.br/artigos/RAS33
_seguranca.pdf
22. Abreu D, Azevedo R, Silva A, Reinners
A, Abreu H. Características e condições de
saúde de uma coorte de idosos que sofreram
quedas. J Nurs UFPE on line [Internet]. 2015
Mar [cited 2015 Mar 18];9(3):7582-9. Available
from:
http://www.revista.ufpe.br/revistaenfermage
m/index.php/revista/article/view/7161
Submission: 2016/05/17 Accepted: 2016/10/23 Publishing: 2016/12/15
Corresponding Address
Andressa Midori Sakai Av. do Café, 170, Ap. 23, Bloco C
CEP 86038-000 Londrina (PR), Brazil
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