VA National Center for Patient Safety Field Office, VAMC, White River Junction, VT; Geisel School of Medicine at Dartmouth, Hanover, NH.
Gen Hosp Psychiatry. 2013 Sep-Oct;35(5):528-36. doi: 10.1016/j.genhosppsych.2013.03.021. Epub 2013 May 20.
One thousand five hundred suicides take place on inpatient psychiatry units in the United States each year, over 70% by hanging. Understanding the methods and the environmental components of inpatient suicide may help to reduce its incidence.
All Root Cause Analysis reports of suicide or suicide attempts in inpatient mental health units in Veterans Affairs (VA) hospitals between December 1999 and December 2011 were reviewed. We coded the method of suicide, anchor point and lanyard for cases of hanging, and implement for cutting, and brought together all other reports of inpatient hazards from VA staff for review.
There were 243 reports of suicide attempts and completions: 43.6% (106) were hanging, 22.6% (55) were cutting, 15.6% (38) were strangulation, and 7.8% (19) were overdoses. Doors accounted for 52.2% of the anchor points used for the 22 deaths by hanging; sheets or bedding accounted for 58.5% of the lanyards. In addition, 23.1% of patients used razor blades for cutting.
The most common method of suicide attempts and completions on inpatient mental health units is hanging. It is recommended that common lanyards and anchor points be removed from the environment of care. We provide more information about such hazards and introduce a decision tree to help healthcare providers to determine which hazards to remove.
美国每年有 1500 名住院精神病患者自杀，其中超过 70%是上吊自杀。了解住院自杀的方法和环境因素可能有助于降低其发生率。
回顾了 1999 年 12 月至 2011 年 12 月期间退伍军人事务部（VA）医院住院心理健康病房自杀或自杀未遂的所有根本原因分析报告。我们对上吊自杀的案例进行了自杀方式、锚固点和拉绳以及切割的实施编码，并汇集了 VA 工作人员报告的所有其他住院危险情况。
共有 243 例自杀未遂和自杀成功报告：43.6%（106 例）是上吊自杀，22.6%（55 例）是切割，15.6%（38 例）是勒死，7.8%（19 例）是服药过量。在 22 例上吊死亡案例中，52.2%的锚固点是门；58.5%的拉绳是床单或被褥。此外，23.1%的患者使用剃须刀片进行切割。
住院心理健康病房最常见的自杀未遂和自杀成功方法是上吊。建议从护理环境中移除常见的拉绳和锚固点。我们提供了更多关于此类危险的信息，并引入了一个决策树来帮助医疗保健提供者确定要移除哪些危险。
