Bell Alyssa, Gallacher Neil
NHS Fife, Scotland.
BMJ Qual Improv Rep. 2016 Jun 6;5(1). doi: 10.1136/bmjquality.u211050.w4430. eCollection 2016.
As part of the Scottish Patient Safety Programme - Mental Health one of the main drivers was the reduction of harm to patients caused by restraint. The aim of this project was to reduce the number of restraints on our Acute Admissions ward. Through use the of the Improvement Model (PDSA), frontline staff were empowered to implement small tests of change at a grassroots level. This approach has led to frontline staff having ownership of driving the changes on a daily basis within the Clinical area. The use of a restraint data collection tool has been adapted and developed with frontline staff to ensure that the staff have ownership of data collected and is used to facilitate improvement. This data is used to inform the development of our Physical Interventions training. Most recently, following analysis, were able to introduce changes to promote the increased use of de-escalation and a shift from prone restraint to the safer seated restraint position. Patient involvement has been paramount with their inclusion in the debrief process. The information gleaned from the patients is used for staff and patient reflection. This has created a learning environment not only for staff but also patients and carers. Everyone involved is able to identify reasons and triggers and generate ideas to reduce the possibility of another restraint. The use of staff and patient safety climate surveys has ensured that we are constantly monitoring improvements in the feeling of safety amongst staff and patients. Our approach has resulted in a change in the culture of restraint resulting in a sustained reduction of 50% in restraint.
作为苏格兰患者安全计划——心理健康项目的一部分，其中一个主要驱动力是减少约束对患者造成的伤害。该项目的目标是减少我们急性入院病房的约束使用次数。通过运用改进模型（计划 - 执行 - 研究 - 改进），一线工作人员被赋予权力，在基层层面进行小规模的变革测试。这种方法使得一线工作人员能够在临床区域内日常推动变革。与一线工作人员共同调整和开发了一种约束数据收集工具，以确保工作人员对所收集的数据拥有所有权，并利用这些数据促进改进。这些数据被用于指导我们身体干预培训的开展。最近，经过分析，我们得以引入一些变革，以促进更多地使用降级干预措施，并从俯卧约束转变为更安全的坐姿约束。患者的参与至关重要，他们被纳入了汇报过程。从患者那里收集到的信息用于工作人员和患者的反思。这不仅为工作人员，也为患者和护理人员创造了一个学习环境。每个参与其中的人都能够识别原因和触发因素，并提出减少再次使用约束可能性的想法。使用工作人员和患者安全氛围调查问卷确保了我们不断监测工作人员和患者安全感的提升情况。我们的方法导致了约束文化的改变，约束使用次数持续减少了50%。
