精神科急性病房意外事件危險因素之回溯性分析

Risk Factors of Accidents in an Acute Psychiatric Ward: A Chart-Review Retrospective Analysis

侯伯勳(Po-Hsun Hou) ； 林志堅(Chih-Chien Lin) ； 卓良珍(Liang-Jen Chuo) ； 陳展航(Chin-Hong Chan) ； 闕清模(Ching-Mo Chuch)

《慈濟醫學雜誌》 11卷3期 (1999/09) Pp. 271-278

https://doi.org/10.6440/TZUCMJ.199909.0271

摘要

目的：精神科病房意外事件的防制和處理，是精神醫療的重要課題；如暴力事件的評估對病人是否需強制住院上極為重要，而跌倒受傷的評估和預防，在臨床照護上則甚為重視。本研究嘗試分析精神科病房意外事件的預測因子。病人及方法：本研究由綜合醫院精神科急性病房之意外事件記錄，由民國82年1月至民國87年1月共蒐集87個個案，其中暴力事件69件(破壞物品42件、攻擊人員18件、自傷行為9件)、跌倒造成肢體損傷14件、逃跑4件，以暴力組和跌倒組分別與控制組間比較，兩組之間針對各項臨床和基本資料比較。結果：以邏輯迴歸分析時以診斷(躁症)、年齡(年輕)、暴力史、使用抗精神病劑量(較高)、住院天數(較久)對暴力事件較具預測性。而對於跌倒造成肢體損傷之意外事件則以診斷(失智症、器質性精神病)、年齡(年長)較具預測價值。結論：本研究結果顯示部分臨床和基本資料，在預測暴力事件和跌倒受傷事件具有意義，此結果在病房防制意外事件上可作為參考。

關鍵字

精神科病房 ； 意外事件 ； 暴力事件

並列摘要

Objective: The prevention and effective handling of accidents in psychiatric wards are of paramount importance. The purpose of this study was to find out predictors caused by violence and falling down. Materials and Methods: The authors collected data on accidents with causes including violence, falling down with physical injury, escape, etc. in an acute psychiatric ward of a general hospital during a 5 year period and compared them with data from a control group of patients. Results: The study included 174 psychiatric patients with 69 violent accidents, 14 falling accidents, 4 escapes, and 87 control patients. Logistic regression revealed the following predictors for accidents caused by violence: younger age, higher dosage of antipsychotics, past history of violent behavior, a diagnosis of mania, and longer hospital stays. In contrast, the route of admission, history of substance abuse, s4ex, marital status, educational level, occupational status, and number of previous admissions were all found to have no influence on predictability. The predictors for accidents caused by falling down were found to be older age and a diagnosis of dementia or organic psychosis. Conclusion: Some demographic and clinical data have been shown to be correlated with predictability for accidents caused by violence or falling down. These findings could provide a useful supplement for the prevention and clinical judgement of accidents.

並列關鍵字

psychiatric ward ； accidents ； violence