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Use of prone position restraint within a mental health trust: A clinical audit of psychiatric practice and methods for improvement

机译：在心理健康信任中使用俯卧位约束：对精神科实践和改善方法的临床审核

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摘要

Purpose - The purpose of this paper is to improve the quality of care of patients presenting with challenging behaviour. Design/methodology/approach - Current guidelines are described, and adherence to the standards is audited, with a particular emphasis on physical restraint. Findings - The results of the clinical audit revealed that in the substantial majority of episodes of challenging behaviour, non-physical techniques were used prior to the need to intervene with physical restraint; however, when physical restraint was used, there was limited use of staff debriefs to facilitate reflection- and work-based learning. A potential diagnostic link to the likelihood of use of prone position restraint was also a finding. The results of a quality improvement project undertaken in response to the findings of the clinical audit demonstrated significant and sustained improvements in adherence to most standards. Practical implications - Continuous improvements to the safety of both patients and staff when managing acute challenging behaviour requires ongoing quality improvement interventions underpinned by the application of human factors principles. Originality/value - The completion of this audit cycle suggests that it is useful to measure specific points of care processes, however, continuous improvement interventions are indicated to lead to sustained improvement - in this paper this is demonstrated by the safer management of challenging behaviour.
机译：目的-本文的目的是提高具有挑战性行为的患者的护理质量。设计/方法/方法-描述当前的指南，并审核对标准的遵守情况，特别强调物理约束。调查结果-临床审核的结果表明，在大多数具有挑战性的行为中，在需要干预身体约束之前使用了非物理技术；但是，当使用身体约束时，很少使用员工汇报，以促进反思和基于工作的学习。一个发现与使用俯卧位约束的可能性的潜在诊断联系也是一个发现。根据临床审核的结果而进行的质量改进项目的结果表明，在遵守大多数标准方面取得了显着且持续的改进。实际意义-在管理急性挑战性行为时，要不断提高患者和医护人员的安全性，就需要持续不断的质量改进干预措施，以人为因素原则为基础。原创性/价值-该审核周期的完成表明，对护理过程的特定点进行衡量非常有用，但是，持续改进干预措施可带来持续改进-在本文中，挑战性行为的更安全管理证明了这一点。

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