Accidental falls among inpatients are a substantial cause of hospital injury. A number of successful experimental studies on fall prevention have shown the importance and efficacy of multifactorial intervention, though success rates vary. However, the importance of staff compliance with these effective, but often time-consuming, multifactorial interventions has not been fully investigated in a routine clinical setting. The purpose of this observational study was to describe the effectiveness of a multidisciplinary quality improvement (QI) activity for accidental fall prevention, with particular focus on staff compliance in a non-experimental clinical setting. This observational study was conducted from July 2004 through December 2010 at St. Luke's International Hospital in Tokyo, Japan. The QI activity for in-patient falls prevention consisted of: 1) the fall risk assessment tool, 2) an intervention protocol to prevent in-patient falls, 3) specific environmental safety interventions, 4) staff education, and 5) multidisciplinary healthcare staff compliance monitoring and feedback mechanisms. The overall fall rate was 2.13 falls per 1000 patient days (350/164331) in 2004 versus 1.53 falls per 1000 patient days (263/172325) in 2010, representing a significant decrease (p = 0.039). In the first 6 months, compliance with use of the falling risk assessment tool at admission was 91.5% in 2007 (3998/4368), increasing to 97.6% in 2010 (10564/10828). The staff compliance rate of implementing an appropriate intervention plan was 85.9% in 2007, increasing to 95.3% in 2010. In our study we observed a substantial decrease in patient fall rates and an increase of staff compliance with a newly implemented falls prevention program. A systematized QI approach that closely involves, encourages, and educates healthcare staff at multiple levels is effective.
入院中の患者の転倒転落は，大腿骨骨折などをきたし，在院日数の延長，患者のQOL低下に大きく関わる重大な事故である1）2）．米国の急性期病院での入院患者の転倒転落発生率（‰=件/1,000入院）は，2001年のInouye3）らの報告によると，3～20‰で，一方わが国における急性期病院の転倒転落率は，2010年から日本病院会が30の急性期病院（2012年度参加施設は145病院）を対象に行っているクオリティーインディケーター（QI）プロジェクト（QIプロジェクト）の報告では0.7～3.8‰とされ，Inouye3）らの報告に比べるとかなり低い．2008年10月1日より，米国のCenter for Medicare and Medicaid Servicesでは，入院中の転倒転落を"never event"「起こってはならないこと」とし，入院中の転倒転落は限りになく予防すべきであるとされている．入院中の転倒転落に関する研究は，世界中で数多く，急性期病院の入院患者を対象とした複合型予防介入プログラムの効果検証を目的としたランダム化比較試験も報告されている． 本誌では，今までに報告された代表的な転倒転落予防に関する研究をまとめ，また，聖路加国際病院における転倒転落予防対策について報告する．
