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首页> 外文期刊>The Psychiatric quarterly >Patterns of Restraint Utilization in a Community Hospital's Psychiatric Inpatient Units
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Patterns of Restraint Utilization in a Community Hospital's Psychiatric Inpatient Units

机译：社区医院精神科住院病房约束使用的模式

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Restraint use in psychiatry has been a topic of clinical and ethical debate for years. As much as the medical community desires to attain the goal of a restraint-free environment, there are not many alternatives available when it comes to protecting the safety of violent patients and those around them. Our objective was to examine patterns of restraint use and analyze the factors leading to its use in adult psychiatric inpatient units. We conducted a retrospective review of restraint orders from January 2007 to December 2012, for inpatient units at a community mental health hospital, examining-unit, patient gender, number and duration of restraint episodes, time of day, and whether medications and/or verbal redirection were used. For the 6-year period studied, a total of 1753 restraint order-sheets were filed for 455 patients. Mixed-model regression found significant differences in duration of restraint episodes depending on: patient gender, unit, medication use, verbal redirection and AM/PM shifts. These differences were consistent over time with no significant interactions with years and remained significant when included together in an overall multivariate model. We elucidate variable patterns of restraint utilization correlating with elements such as patient gender, time of day and staff shift, medication use, and attempts at verbally redirecting the patient. Besides providing much needed data on the intricate dynamics influencing restraint use, we suggest steps to implement hospital-wide restraint-reduction initiatives including cultural changes related to restraint usage, enhanced staff-training in conflict de-escalation techniques and personalized treatment plans for foreseeable restraint episodes.
机译：多年来，在精神病学中使用约束一直是临床和伦理学辩论的话题。尽管医学界希望实现无约束环境的目标，但在保护暴力患者及其周围患者的安全方面，没有太多其他选择。我们的目标是检查束缚器的使用方式，并分析导致其在成人精神病住院患者中使用束缚器的因素。我们对2007年1月至2012年12月的约束令进行了回顾性审查，涉及社区精神卫生医院的住院单位，检查单位，患者性别，约束发作的次数和持续时间，一天中的时间以及是否使用药物和/或口头使用重定向。在为期6年的研究中，共向455例患者提交了1753份约束令。混合模型回归发现约束发作的持续时间存在显着差异，具体取决于：患者性别，单位，药物使用，语言重定向和AM / PM移位。这些差异随着时间的推移是一致的，并且与年份之间没有显着的交互作用，并且当将它们一起包含在整体多元模型中时，这些差异仍然很明显。我们阐明了约束利用的可变模式，这些约束与诸如患者性别，一天中的时间和人员轮换，药物使用以及口头重定向患者的尝试等因素相关。除了提供影响约束使用的复杂动态方面的大量数据外，我们还建议采取措施实施全院范围内的约束减少举措，包括与约束使用相关的文化变革，加强员工对冲突降级技巧的培训以及针对可预见约束的个性化治疗计划情节。

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