Marcus Steven C, Hermann Richard C, Cullen Sara Wiesel
From the School of Social Policy & Practice, University of Pennsylvania, Philadelphia, Pennsylvania.
Institute for Clinical Research and Health Policy Studies, Tufts School of Medicine, Tufts Medical Center, Boston, Massachusetts.
J Patient Saf. 2021 Dec 1;17(8):e1452-e1457. doi: 10.1097/PTS.0000000000000520.
The past 20 years have seen the emergence of a national movement to improve hospital-based healthcare safety in the United States. However, much of the foundational work and subsequent research have neglected inpatient psychiatry. The aim of this article was to advance a comprehensive approach for conceptualizing patient safety in inpatient psychiatry as framed by an application of the Institute of Medicine patient safety framework.
This article develops a framework for characterizing patient safety in hospital-based mental health care. We discuss some of the conceptual and methodological issues related to defining what constitutes a patient safety event in inpatient psychiatry and then enumerate a comprehensive set of definitions of the types of safety events that occur in this setting.
Patient safety events in inpatient psychiatry are broadly categorized as adverse events and medical errors. Adverse events are composed of adverse drug events and nondrug adverse events, including self-harm or injury to self, assault, sexual contact, patient falls, and other injuries. Medical errors include medication errors and nonmedication errors, such as elopement and contraband. We have developed clear definitions that would be appropriate for use in epidemiological studies of inpatient mental health treatment.
Psychiatry has not been an integral part of the national safety movement. As a first step toward breaching this chasm, we have considered how psychiatric events fit into the safety framework adopted across much of medicine. Patient safety should become a key part of inpatient psychiatry's mission and pursued rigorously as the subject of research and intervention efforts.
在过去20年里，美国出现了一场旨在改善医院医疗安全的全国性运动。然而，许多基础工作及后续研究都忽视了住院精神病学。本文的目的是提出一种全面的方法，以将住院精神病学中的患者安全概念化，这一方法是由医学研究所的患者安全框架应用所构建的。
本文构建了一个用于描述医院心理健康护理中患者安全的框架。我们讨论了一些与定义住院精神病学中构成患者安全事件的因素相关的概念和方法问题，然后列举了在这种情况下发生的各类安全事件的一套全面定义。
住院精神病学中的患者安全事件大致分为不良事件和医疗差错。不良事件由药物不良事件和非药物不良事件组成，包括自我伤害、袭击、性接触、患者跌倒及其他伤害。医疗差错包括用药差错和非用药差错，如擅自离院和违禁品问题。我们已经制定了清晰的定义，适用于住院心理健康治疗的流行病学研究。
精神病学尚未成为全国安全运动的一个组成部分。作为弥合这一差距的第一步，我们思考了精神科事件如何融入医学大部分领域所采用的安全框架。患者安全应成为住院精神病学使命的关键部分，并作为研究和干预工作的主题得到严格推行。
