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Abstract:
Introduction: Old age is an unavoidable
and a natural process that nobody can deny.
But the aging process attends with many
physical and psychological difficulties.
The
purpose of this research is to specify the
measure of observance of safety principles
in the prevention of adverse events for
confined elderly patients in different parts
of the curing-instructional headquarters,
of Shiraz Medical Sciences University.
Articles
and methods: In this investigation a
questionnaire was provided consisting of
77 questions on the basis of design purposes.
After specifying its scientific credits,
the hospital's situation was assessed in
connection with the measure of observance
safety principles in prevention of adverse
events for confined elderly patients. The
study method was in the form of a descriptive-cross-sectional
and observational study and elderly patients
confined to bed are the study group. The
gathered information was analyzed via checklists
and observations by SPSS software.
Conclusions:
Summary of research obtained showed that
the entire hospital confines elderly patients
to bed. The measure of observance of safety
principles had been in Namazi hospital 62.5%,
in Chamran hospital 54.5% and in Faghihi
hospital 36.2%. Namazi hospital and Faghihi
hospital have the most and the least safety,
respectively. In considering aspects of
patients in wards, the measure of observance
of safety principles specified: Bathroom
situation, W.C situation, stairways, floors,
windows, danger bell, elevators, and transport
means in every ward of the hospitals.
Discussion:
Conclusions showed that regading the safety
situation in different wards of curing-instructional
hospitals of Shiraz Medical Sciences University
and the elderly patients confined there,
all aspects were lower than accepted standards,
except Namazi Hospital. Some recommendations
are put forward regarding observance of
safety principles to prevent adverse events
for confined elderly in hospitals.
Keywords:
Safety principles, events, confined elderly
people.
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Introduction
Old age is a common
biological process for all living creatures. In
fact all of us begin to age when we are born.
We can't stop or reverse this process but it can
be delayed with correct attention.
Deficiency and debility
in old age can be prevented or minimised with
strategies and attention.(1)
Because of the ever-increasing
growth of the population above 65 years, consideration
of hygiene and health of the elderly has special
importance.(2)
Security and safety
is essential for every person and all centres
such as perimeters of working houses, society
and curing centers should heed safety information.
All people are exposed
to danger and age specific observance of safety
points is required.(2)
Although old people
have more experience with their environment, disease
or grades of injuries can increase the danger
of adverse events in old people. This group of
ten was liable to fall or collapse, which is a
major problem, and a cause of death in old people.
Mortality from falling increases with the rise
in age. The possibility of falling or collapsing
for old women is more than in old men which accounts
for higher female representation in this age group.
Investigations show that more than 1/3 of falls
or collapse in old people happen because of the
necessity to urinate.(7)
From diseases and
events, 1/5 old people in the course of last year
were studied and a few less than these were confined
to bed as the result of diseases and events.(5)
The local hospital
is crowded, and full of stress. Hospitals should
operate like a hotel and staff should undertake
responsibilities in securing safety for patients.(8)
If people enter
an environment or a society in which they don't
have any information about particulars, or social
orders of the environment or society, they will
feel insecure. The hospital environment is for
old patients, a strange environment and will therefore
cause old patients to feel insecure and watchful
whereas the hospital has a duty to create a secure
and quiet environment, to obtain physical and
psychological security of patients.(6)
When confined to
bed old patients in hospitals should, along with
their attendants, get acquainted with the whole
part of hospital, and it should be explained to
them about making use of places such as bedrooms,
corridors, W.C and bathrooms.(2)
To distinguish situations
that can precipitate an event is essential, therefore
old patients must be watchful of any kind of activity
that can cause injury or any object that can cause
an adverse event. Also they should consider the
patient's environment in regard of any dangers,
such as bare electricity wires, stools that have
settled in unfit places, slipperiness of floors
and any condition that can cause accidents.(7)
One standard in
the prevention of adverse events is to have patient
environments similar: e.g. patient bed, ward lighting,
danger bell, wheel chairs, stairs, W.C, bathroom,
patient environment, clothes, the table, sleep-light,
elevator and safety vest.(7) In accordance with
accomplished investigations 75% all of events
that occur for old people, happen in the home
environment. Moreover, old people use hospital
services and health services more than other age
groups. The most important events for confined
old patients consist of: falling and electrocution,
with falling or collapsing the most prevalent
kind of event.(8)
The United Nations
organization statistical yearbook outlines that
in Argentina, America, France, Germany and England
old age ratio to population is more than 12% while
in Chile, Paraguay, Turkey and Singapore it is
between 7 and 12% and in Algeria, Egypt, Senegal,
Bangladesh, Indonesia, Iran and Pakistan it is
less than 12%. The biggest ratio of elderly population
is in west European countries and the smallest
ratio in African and Asian countries. The ratio
of elderly population in Iran is 5.4% of the whole
Iranian population.(3)
Researchers show
that adverse events are common for confined patients
in hospital wards, but any statistics of these
events are not available and there are no measures
in place for prevention of these events.In regard
to the above subjects, education is important
in this connection and will decrease the likelihood
of adverse events from taking place.
Article and methods:
The method employed was a descriptive-cross-sectional
and observational study and the study population
is old patients confined to bed wards in curing-instructional
headquarters of Shiraz Medical Sciences University,
particularly in three hospitals of curing-instructional
(Namazi, Chamran, Faghihi). Therefore the sample
consisted of entire wards of confined elderly
patients in these hospitals.Tools for gathering
of the information according to research purposes
by observation and check list, consisted of 77
questions in the fields of: situation of patients'
beds (7 questions), room light (2 questions),
s. floor (2 questions), s. windows (2 questions),
ward corridor (6 questions), s. bathroom (10 questions),
s.w.c (6 questions), s. stairs (10 questions),
s. elevators (6 questions) and other points (26
questions).
To adhere to scientific
principles the last check list was prepared with
reference to each of the wards confining elderly
patients and then with attention to the questions
in the check list and observation from wards.
The gathered information was analyzed by SPSS
software and then the measure of observance safety
in different wards of hospitals in the prevention
of adverse events for patients, has been shown
in the form of percentages in table format.
Conclusion
The research data showed
that in Namazi hospital 24 wards consisted of:
men surgery 2 wards, internal heart 1 ward, old
C.C.U 3 wards, new C.C.U 10 wards, orthopedic
1 ward, kidney link 1 ward, urology 1 ward, women
surgery 1 ward, womeninternal 1 ward, neurosurgery
1 ward, men internal 1 ward. And in Chamran hospital
6 wards consisted of: men orthopedic 2 wards,
women orthopedic 1 ward, neurology 3 wards, neurosurgery
4 wards, jaw and face surgery 5 wards, rehabilitation
6 wards. And in Faghihi hospital consisted of
8 wards: men surgery 1 ward, women surgery 2 wards,
C.C.U 3 wards, heart surgery 4 wards, men internal
5 wards, women internal 6 wards, skin 8 wards,
pulmonary 7 wards, has been confining elderly
patients.
To explain this point
it is essential to note that the in the I.C.U
ward patients are in a coma and cannot use the
danger bell, table and wheel chair and also in
the dialysis and ambulance wards because in these
wards patients were confined less than 6 hours
therefore these wards have not been included.
Investigation showed that old patients were confined
to bed in the whole curing-instructional hospitals
parts of Shiraz Medical Sciences University.
In connection to the safety
measures for old people confined in hospital,
the conclusion of the study revealed that on average
the measure of observance of safety points has
been in 14 parts Namazi hospital (62.51%) in 6
parts Chamran hospital (54.5 %) and in 8 parts
Faghihi hospital (36.2 %) see Table 1). The measure
of observance of safety points in Namazi hospital
is more than other hospitals. Investigation also
revealed the measure of safety in each of the
different parts of the hospitals shows that in
Namazi hospital, parts of urology ward with (65
%) and C.C.U, men, with (65 % safety), is the
safest part of that hospital. While male wards
(58 %) are the most in secure. In Chamran hospital,
the female orthopedic ward with 63.5 % safety,
is the safest part and male orthopedic ward with
49 % safety, is the least safe. In Faghihi hospital
wards male internal ward with 25 % safety is the
most insecure and skin wards and male C.C.U wards
with 47 % safety are the safest wards.
Table no.1 - The measure
of safety wards of Shiraz Hospitals
|
Namazi Hospital |
Chamran Hospital |
Faghihi Hospital |
Situation of safety factors |
| 70 |
54 |
39 |
Bed |
| 100 |
100 |
93 |
Light of rooms |
| 100 |
100 |
72 |
Floor |
| 50 |
50 |
50 |
Windows |
| 55 |
58 |
12.5 |
Danger bell |
| 78 |
53 |
25 |
Measure of transport |
| 33 |
5.5 |
16.25 |
W.C |
| 40 |
18.5 |
16 |
Bathroom |
| 65 |
36 |
56 |
Corridor |
| 100 |
66 |
33 |
Elevators |
| 66 |
66 |
54.1 |
Rtairs |
| 100 |
100 |
90 |
Table of food |
Detail of our investigations,
relating to hospital wards are shown in Table
No.1. It shows that in Namazi hospital the measure
of observance of safety points, room light, floor,
condition of table, and elevators, with 100%,
have the most safety and the situation of W.C
33%, bathroom 40% have the least safety. In Chamran
hospital it is similar to Namazi hospital regarding
the condition of rooms light, floor, table with
100% safety, have the best safety and the situation
of W.C with 5.5%, bathroom with 18.5% and corridor
with 36% have the least safety. In Faghihi hospital
condition of room lights at 93% have the most
safety and the situation of patient's beds with
39%, danger bell safety with 12.5% bathroom 16%,
elevators with 33% and means of transport 25%
and W.C with 16.25%, have the least safety.
More investigation showed
that the situation in Faghihi hospital is the
least safe.
Discussion
Discussion: In
the present research we measured the observance
of safety principles considered in relation to
prevention of adverse events for confined old
patients in different parts of curing-instructional
head quarters Shiraz Medical Sciences University.
The need for health and
safety of both psychological and physical health,
and physical safety means that the person should
be protected from certain and probable dangers.
Patient education to prevent adverse events, is
required to avoid fear and agitation. No complicity
in the safety needs of patients will cause fear
and anxiety.(5)
Hospitals are places where
many patients are referred to be cured. Usually
the hospital environment is full of stress. Therefore
responsible staff should undertake to secure safety
of all patients and to distinguish conditions
that can cause adverse events, and to create essential
and suitable policies.(8)
Farrell in 1990 stated
that the most important effective subject in adverse
events for confined elderly patients in hospital
wards relate to the subject and to the hospital
environment and the prevention of adverse events
relating to the beds of patients, room lighting,
floors, windows, danger bell, W.C, bathroom, corridor,
elevators, stairs and situation of tables, which
should conform to hospital standards. Fisher in
2002 has done research on environmental events
for old people in Maitland Hospital, Australia.
Our results show that
because of no attention to safety points in hospitals,
60% of events were connected with falls in hygienic
services, 62% related to floor of corridors and
kitchen, 60% related to stairs or ladders, 87%
related to injuries issuing from falling or collapsing.
Wyatt and his partners in 2003 in England investigated
falling in elderly patient,s from stairs in house
and hospitals then concluded that 53% of these
patients died due to falling or collapsing from
stairs. Therefore stairs are an important danger
for old patients. In the present study the conclusion
showed that in Namazi hospital the measure of
observance of safety points is more than in Faghihi
and Chamran hospitals; also the measure of observance
of safety points in different wards of Faghihi
hospitals have the lowest safety record. Therefore
the probability of danger lurks for elderly patients.
With attention to the
results of this study we offer the following advice
to provide safety measures in curing-instructional
hospitals of Shiraz Medical Sciences University:
1. To advise observance of safety points regarding
transport to hospitals, and staff to give suitable
instruction about creating a safe environment
and the necessary actions to overcome deficiencies.
2. To register adverse events and to investigate
the reasons for events and to overcome them.
3. Education of elderly patients regarding how
to use beds, and items surrounding the bed and
observance of safety points.
4. To provide suitable assistance for movement
of elderly confined patients (e.g. sticks and
walkers)
5. To investigate and report hygienic services,
bathrooms, corridor and stairs which do not meet
required standards.
6. To confine elderly patients in separate rooms
for control and prevention of adverse events.
