Mills Peter D, Watts B Vince, Miller Steven, Kemp Jan, Knox Kerry, DeRosier Joseph M, Bagian James P
Department of Veterans Affairs National Center for Patient Safety Field Office, White River Junction, Vermont, USA.
Jt Comm J Qual Patient Saf. 2010 Feb;36(2):87-93. doi: 10.1016/s1553-7250(10)36015-6.
Approximately 1,500 suicides take place in inpatient hospital units in the United States each year. This study, the first of its kind, examines the implementation and effectiveness of using a standardized checklist for mental health units to improve patient safety in a large health care system.
In 2006 a Department of Veterans Affairs (VA) committee was charged with developing a checklist to explicitly identify environmental hazards on acute mental health units treating suicidal patients. The committee developed both general guidelines to be applied to all areas of the psychiatric unit and detailed guidelines for specific rooms, such as bathrooms, bedrooms, and seclusion rooms.
Some 113 VA facilities used the Mental Health Environment of Care Checklist to evaluate their mental health units, identifying and rating 7,642 hazards. At the end of the first year of the project, because of the checklist, 5,834 (76.3%) of these hazards had been abated by facilities; approximately 2% were identified as critical hazards, and another 27% were rated as serious. The most common hazard was anchor points for hanging, followed by material that could be used as a weapon against staff or other patients and problems keeping patients in the secured unit environment. Anchor points had the greatest risk-level classification, followed by suffocation risk and poison risk. High-risk locations included bedrooms and bathrooms.
Anchor points represented almost 44% of the total number of identified hazards, and materials that could be used as weapons comprised nearly 14% of the total. It is critical to review the mental health environment of care with an eye for these potential weapons. The checklist and resulting mitigations of hazards represent steps toward the overall goal of preventing inpatient suicides.
在美国，每年约有1500起自杀事件发生在住院病房。本研究是同类研究中的首例，旨在考察在大型医疗系统中，使用标准化检查表改善精神科病房患者安全的实施情况及效果。
2006年，退伍军人事务部（VA）委员会受命制定一份检查表，以明确识别治疗自杀患者的急性精神科病房的环境危害。该委员会制定了适用于精神科所有区域的一般准则，以及针对特定房间（如浴室、卧室和隔离室）的详细准则。
约113家VA医疗机构使用《精神科护理环境检查表》对其精神科病房进行评估，识别并评级了7642处危害。在项目第一年结束时，由于该检查表，各机构消除了其中5834处（76.3%）危害；约2%被确定为严重危害，另有27%被评为重度危害。最常见的危害是悬挂固定点，其次是可被用作攻击工作人员或其他患者的物品，以及在安全病房环境中防止患者逃脱的问题。悬挂固定点的风险等级分类最高，其次是窒息风险和中毒风险。高风险区域包括卧室和浴室。
悬挂固定点占已识别危害总数的近44%，可被用作武器的物品占总数的近14%。以这些潜在武器为着眼点审查精神科护理环境至关重要。检查表及由此产生的危害缓解措施是朝着预防住院患者自杀这一总体目标迈出的步伐。
