A Checklist to Identify Inpatient Suicide Hazards in Veterans Affairs Hospitals
A Checklist to Identify Inpatient Suicide Hazards in Veterans Affairs Hospitals
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DOI：
10.1016/s1553-7250(10)36015-6
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发表时间：
2010-02-01
影响因子：
2.3
通讯作者：
Bagian, James P.
中科院分区：
文献类型：
--
作者：
Mills, Peter D.;Watts, B. Vince;Bagian, James P.
背景：美国每年约有1,500例自杀发生在住院医院。这项研究，第一次，探讨了使用一个标准化的清单，精神卫生单位，以提高病人的安全性，在一个大型health care system.Methods：在2006年的退伍军人事务部（VA）委员会负责制定一份清单，明确确定环境危害急性精神卫生单位治疗自杀患者的实施和有效性。该委员会制定了一般准则，适用于所有领域的精神科和详细的指导方针，为特定的房间，如浴室，卧室，和隔离rooms.Results：一些113 VA设施使用的精神卫生环境的护理清单，以评估他们的精神卫生单位，确定和评级7,642危害。在项目第一年结束时，由于清单，这些危险中有5，834（76.3%）已被设施消除;约2%被确定为重大危险，另有27%被评为严重危险。最常见的危害是悬挂的锚点，其次是可用作针对工作人员或其他患者的武器的材料，以及将患者保持在安全的单元环境中的问题。锚点的风险等级最高，其次是窒息风险和中毒风险。讨论：锚点占已确定危险总数的近44%，可用作武器的材料占总数的近14%。至关重要的是，要审查护理的心理健康环境，注意这些潜在的武器。该清单和由此产生的危害缓解措施代表了预防住院患者自杀的总体目标。
Background: Approximately 1,500 suicides take place in inpatient hospital units in the United States each year. This study, the first of its kind, examines the implementation and effectiveness of using a standardized checklist for mental health units to improve patient safety in a large health care system.Methods: In 2006 a Department of Veterans Affairs (VA) committee was charged with developing a checklist to explicitly identify environmental hazards on acute mental health units treating suicidal patients. The committee developed both general guidelines to be applied to all areas of the psychiatric unit and detailed guidelines for specific rooms, such as bathrooms, bedrooms, and seclusion rooms.Results: Some 113 VA facilities used the Mental Health Environment of Care Checklist to evaluate their mental health units, identifying and rating 7,642 hazards. At the end of the first year of the project, because of the checklist, 5,834 (76.3%) of these hazards had been abated by facilities; approximately 2% were identified as critical hazards, and another 27% were rated as serious. The most common hazard was anchor points for hanging, followed by material that could be used as a weapon against staff or other patients and problems keeping patients in the secured unit environment. Anchor points had the greatest risk-level classification, followed by suffocation risk and poison risk. High-risk locations included bedrooms and bathrooms.Discussion: Anchor points represented almost 44% of the total number of identified hazards, and materials that could be used as weapons comprised nearly 14% of the total. It is critical to review the mental health environment of care with an eye for these potential weapons. The checklist and resulting mitigations of hazards represent steps toward the overall goal of preventing inpatient suicides.