Vanderbilt University Medical Center, Nashville, TN, USA.
Vanderbilt University School of Nursing, 461 21st Ave, 407 GH, Nashville, TN, 37240, USA.
Trials. 2020 May 24;21(1):417. doi: 10.1186/s13063-020-04278-2.
Disruptive behavior in hospitalized patients has become a priority area of safety concern for clinical staff, and also has consequences for patient management and hospital course. Proactive screening and intervention of patients with behavioral comorbidities has been reported to reduce disruptive behavior in some settings, but it has not been studied in a rigorous way.
The Disruptive bEhavior manageMEnt ANd prevention in hospitalized patients using a behaviORal intervention team (DEMEANOR) study is a pragmatic, cluster, crossover trial that is being conducted. Each month, the behavioral intervention team, comprising a psychiatric-mental health advanced practice nurse and a clinical social worker, with psychiatrist consultation as needed, rotates between an adult medicine unit and a mixed cardiac unit at Vanderbilt University Medical Center in Nashville, TN, USA. The team proactively screens patients upon admission, utilizing a protocol which includes a comprehensive chart review and, if indicated, a brief interview, seeking to identify those patients who possess risk factors indicative of either a potential psychological barrier to their own clinical progress or a potential risk for exhibiting disruptive, aggressive, or self-injurious behavior during their hospitalization. Once identified, the team provides interventions aimed at mitigating these risks, educates and supports the patient care teams (nurses, physicians, and others), and assists non-psychiatric staff in the management of patients who require behavioral healthcare. Patients who are both admitted to and discharged from either unit are included in the study. Anticipated enrollment is approximately 1790 patients. The two primary outcomes are (1) a composite of objective measures related to the patients' disruptive, threatening, or acting out behaviors, and (2) staff self-reported comfort with and confidence in their ability to manage patients exhibiting disruptive, threatening, or acting out behavior. Secondary outcomes include patient length of stay, patient attendant (sitter) use, and the unit nursing staff retention.
This ongoing trial will provide evidence on the real-world effectiveness of a proactive behavioral intervention to prevent disruptive, threatening, or acting out events in adult hospitalized patients.
ClinicalTrials.gov: NCT03777241. Registered on 14 December 2018.
在住院患者中，破坏性行为已成为临床工作人员关注的重点安全领域，也会对患者管理和医院流程产生影响。在某些情况下，对伴有行为并发症的患者进行主动筛查和干预已被报道可减少破坏性行为，但尚未进行严格的研究。
使用行为干预团队（DEMEANOR）对住院患者进行的破坏性行为管理和预防研究是一项实用的、集群的、交叉试验，正在进行中。每月，行为干预团队包括一名精神科-心理健康高级执业护士和一名临床社会工作者，必要时咨询精神科医生，在美国田纳西州纳什维尔范德比尔特大学医学中心的成人内科病房和混合心脏病房之间轮转。该团队在患者入院时主动进行筛查，使用包括全面病历回顾和如有必要进行简短访谈的方案，旨在识别那些具有潜在心理障碍或在住院期间表现出破坏性行为、攻击性或自伤行为风险的患者。一旦确定，团队将提供旨在减轻这些风险的干预措施，教育和支持患者护理团队（护士、医生和其他人员），并协助非精神科工作人员管理需要行为医疗保健的患者。研究包括同时入住和出院的两个病房的患者。预计纳入约 1790 名患者。两个主要结果是：（1）与患者的破坏性行为、威胁性行为或表现出的行为相关的客观测量的综合指标；（2）工作人员对自己管理表现出破坏性行为、威胁性行为或表现出的行为的患者的舒适度和信心的自我报告。次要结果包括患者的住院时间、患者的护理人员（护工）使用情况以及单元护理人员的保留率。
正在进行的试验将提供关于预防成人住院患者出现破坏性行为、威胁性行为或表现出的行为的主动行为干预的真实世界有效性的证据。
ClinicalTrials.gov：NCT03777241。于 2018 年 12 月 14 日注册。
