Murdoch Childrens Research Institute, University of Melbourne, Melbourne, VIC, Australia.
Med J Aust. 2012 Feb 20;196(3):198-201. doi: 10.5694/mja11.10257.
To describe the development, structure and implementation of a formal system of aggression management, and to document its utilisation during the first year of operation.
A prospective audit at the Royal Children's Hospital, a major children's hospital in Melbourne.
Analysis of utilisation patterns from prospective data forms augmented by retrospective review of security logs and medical records for 14 months from launch in December 2006.
Staff from four different clinical areas, led by an emergency consultant and a hospital administrator, made up the rostered multidisciplinary "code grey" team. Over 14 months, there were 104 incidents when the team was activated, involving patients in 75 cases and visitors in 29 cases. Incidents occurred at equal frequency on wards and in the emergency department. Patients involved were most commonly affected by a mental disorder, frustration and/or a developmental disability. The apparent cause of visitor aggression was mainly frustration and occasionally drugs. The majority of patient aggressors showed physical aggression towards people or objects or self-harming behaviour. Visitor aggressors were mostly verbally aggressive (and occasionally physically violent). For patients, the team used verbal de-escalation (56/75 events), physical restraint (34/75), sedation (23/75) and mechanical restraint (15/75). For visitors, verbal de-escalation occurred in 17/29 cases and 10/29 visitors left or were removed. Several patient and staff injuries were documented.
An aggression management team can be established in a children's hospital setting. This team structure provides a useful response to concerns about staff safety and optimal patient care.
描述一个正式的攻击管理系统的开发、结构和实施，并记录其在运行第一年的使用情况。
在墨尔本一家主要儿童医院皇家儿童医院进行的前瞻性审计。
从启动后 14 个月的前瞻性数据表格中分析使用模式，并通过回顾性审查安全日志和病历进行补充。
由一名急诊顾问和一名医院管理人员领导的来自四个不同临床科室的工作人员组成了多学科的“代码灰色”团队。在 14 个月期间，团队共被激活 104 次，涉及 75 例患者和 29 例访客。病房和急诊部门发生的事件频率相等。涉及的患者最常见的是精神障碍、挫折和/或发育障碍。访客攻击的明显原因主要是挫折和偶尔的药物。大多数患者攻击者表现出对人和物体的身体攻击或自残行为。访客攻击者主要是言语攻击（偶尔是身体暴力）。对于患者，团队使用言语降级（75 次事件中的 56 次）、身体约束（75 次中的 34 次）、镇静（75 次中的 23 次）和机械约束（75 次中的 15 次）。对于访客，29 次事件中的 17 次和 29 次访客中的 10 次使用了言语降级，有 10 次访客离开或被带走。记录了一些患者和工作人员受伤的情况。
在儿童医院环境中可以建立攻击管理团队。这种团队结构为解决工作人员安全和最佳患者护理问题提供了有用的应对措施。
