Succeeding in Sustained Reduction in the use of Restraint using the Improvement Model.
Succeeding in Sustained Reduction in the use of Restraint using the Improvement Model.
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DOI：
10.1136/bmjquality.u211050.w4430
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发表时间：
2016-01-01
期刊：
影响因子：
--
通讯作者：
Gallacher, Neil
中科院分区：
文献类型：
--
作者：
Bell, Alyssa;Gallacher, Neil
作为苏格兰患者安全方案--心理健康的一部分，主要驱动力之一是减少约束对患者造成的伤害。这个项目的目的是减少我们急性入院病房的限制数量。通过使用改进模式(PDSA)，前线工作人员有权在基层实施小规模的变革测试。这种方法导致了前线工作人员拥有在临床领域内每天推动变化的所有权。与前线工作人员一起调整和发展了约束数据收集工具的使用，以确保工作人员对收集的数据拥有所有权，并用于促进改进。这些数据被用来为我们的身体干预训练的发展提供信息。最近，经分析后，这些国家能够作出改变，以促进更多地使用降级措施，并从俯卧约束转向更安全的座式约束。患者的参与一直是最重要的，他们被纳入汇报过程。从病人那里收集的信息被用于工作人员和病人的反思。这不仅为工作人员创造了学习环境，也为患者和护理人员创造了学习环境。参与其中的每个人都能够找出原因和触发因素，并提出想法，以减少再次受到限制的可能性。工作人员和患者安全气氛调查的使用确保了我们不断监测工作人员和患者的安全感的改善。我们的做法改变了克制文化，导致克制持续减少50%。
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.