降低急性精神科病房病人自傷發生率

Reductions in the Incidence Rate of Self-Injury at the Inpatient Psychiatric Unit

林如玉(Ju-Yu Lin) ； 劉秀雲(Hsiu-Yun Liu)

《臺大護理雜誌》 14卷1期 (2018/01) Pp. 115-128

https://doi.org/10.6740/NTUHJN.201801_14(1).0012

摘要

本精神科病房2012年自傷行為發生率0.08%，較2011年上升0.05%。自傷行為是影響精神科病人生命安全問題的主要因素之一，因此引發專案小組改善動機。此改善專案目的為將精神科住院病人自傷發生率降低至小於0.03%。經調查發現主要原因為保全人員門禁安全檢查不夠嚴謹、自殺風險異動時，外出醫囑沒有及時調整、訪客不配合安全檢查，透過加強門禁檢查流程共識、建立「第一次外出時，說明安檢之標準作業流程」、落實自殺風險升級時，立即進行外出醫囑的調整、落實照顧者對於自傷高風險個案的陪伴功能、建立「發放陪病卡」的標準流程及修訂探訪管理規範、落實水晶或人工指甲管理。專案成效為2013年病人自傷發生率由0.08%降至0.01%。由此結果可知主要照顧者、訪客和醫療團隊共同配合，才能促使治療環境更加安全，有效降低住院病人自傷發生率。

關鍵字

自傷 ； 精神科病房

並列摘要

The rate of self-injury was 0.08% in 2012, which was significantly higher than 0.03% in 2011, recorded at our inpatient psychiatric unit. Self-injury is the major cause of suicide, which motivates us to develop this project. This project aimed to lower the self-injury rate below 0.03%. The leading causes of self-injury included the incomplete standard safety check by security staff, the patient's temporary out of unit order not changed immediately at the time of the increased patient's self-injury risk, and non-compliance of visitors with the safety check. Strategies developed for this project were establishing the team's agreements on the standard safety check and the instruction of the standard safety check for the patients leaving the unit for the first time, immediately changing orders to prevent vulnerable patients with self-injury risk from exiting the unit, enhancing caregiver's effectively accompany with the patient, establishing visitor guidelines, safety check at the patient's first time out of the unit, modifying the standard procedure for the patients' visitors, and establishing the crystal or artificial nails management. The rate of self-injury decreased from 0.08% in 2012 to 0.01% in 2013. The cooperation of caregivers, visitors, and health professionals can effectively decrease the rate of self-injury at our inpatient psychiatric unit.

並列關鍵字

self-injury ； inpatient psychiatric unit