Background Hospital falls continue to be a persistent global issue with serious harmful consequences for patients and health services. Many clinical practice guidelines now exist for hospital falls, and there is a need to appraise recommendations. Method A systematic review and critical appraisal of the global literature was conducted, compliant with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Web of Science, Embase, CINAHL, MEDLINE, Epistemonikos, Infobase of Clinical Practice Guidelines, Cochrane CENTRAL and PEDro databases were searched from 1 January 1993 to 1 February 2024. The quality of guidelines was assessed by two independent reviewers using Appraisal of Guidelines for Research and Evaluation Global Rating Scale and Appraisal of Guidelines of Research and Evaluation Recommendation Excellence (AGREE-REX). Certainty of findings was rated using Grading of Recommendations Assessment, Development and Evaluation Confidence in Evidence from Reviews of Qualitative Research. Data were analysed using thematic synthesis. Results 2404 records were screened, 77 assessed for eligibility, and 20 hospital falls guidelines were included. Ten had high AGREE-REX quality scores. Key analytic themes were as follows: (i) there was mixed support for falls risk screening at hospital admission, but scored screening tools were no longer recommended; (ii) comprehensive falls assessment was recommended for older or frail patients; (iii) single and multifactorial falls interventions were consistently recommended; (iv) a large gap existed in patient engagement in guideline development and implementation; (v) barriers to implementation included ambiguities in how staff and patient falls education should be conducted, how delirium and dementia are managed to prevent falls, and documentation of hospital falls. Conclusion Evidence-based hospital falls guidelines are now available, yet systematic implementation across the hospital sector is more limited. There is a need to ensure an integrated and consistent approach to evidence-based falls prevention for a diverse range of hospital patients.

中文翻译：

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医院跌倒临床实践指南：全球分析和系统评价


背景 医院跌倒仍然是一个持续存在的全球性问题，对患者和卫生服务造成严重有害后果。现在有许多针对医院跌倒的临床实践指南，并且需要评估建议。方法 根据系统评价和荟萃分析指南的首选报告项目，对全球文献进行系统评价和批判性评估。检索时间为 1993 年 1 月 1 日至 2024 年 2 月 1 日。检索了 Web of Science、Embase、CINAHL、MEDLINE、Epistemonikos、Infobase of Clinical PracticeGuidelines、Cochrane CENTRAL 和 PEDro 数据库。指南的质量由两名独立评审员使用研究指南评估进行评估和评估全球评级量表和卓越研究和评估推荐指南评估（AGREE-REX）。研究结果的确定性通过定性研究审查中的建议评估、制定和评估证据置信度分级进行评级。使用主题综合分析数据。结果 筛选了 2404 条记录，评估了 77 条记录的资格，并纳入了 20 条医院跌倒指南。十个具有较高的 AGREE-REX 质量得分。 主要分析主题如下：(i) 对于入院时跌倒风险筛查的支持不一，但不再推荐评分筛查工具； (ii) 建议对老年或体弱的患者进行全面跌倒评估； (iii) 一致建议采取单因素和多因素跌倒干预措施； (iv) 患者参与指南制定和实施方面存在很大差距； (v) 实施障碍包括如何开展工作人员和患者跌倒教育、如何管理谵妄和痴呆症以预防跌倒以及医院跌倒记录等方面的模糊性。结论 目前已有基于证据的医院跌倒指南，但整个医院部门的系统实施却较为有限。需要确保针对不同类型的医院患者采取综合且一致的循证跌倒预防方法。