精神科の集中治療中の抑止力の低下: 文化変化介入の制御された二相時間系列評価

Eleanor Green¹, Stephen Kellett², Chris Gaskell³

¹The University of Sheffield, Sheffield, UK eleanor.green16@nhs.net.

BMJ open quality

|September 2, 2025

まとめ

制限的な介入を減らすことに焦点を当てた新しい役割の実施は,精神科集中治療室 (PICU) で孤立と抑制の使用を大幅に減少させた. この文化変化の介入により安全性と患者のケアが改善されました

科学分野:

精神科
医療管理
患者の安全

背景:

身体的拘束,迅速な鎮静,隔離などの制限的慣行は,精神病患者の安全リスクを管理するために採用されます.
これらの行為は患者とスタッフの両方にとって身体的・心理的な重大な危険をもたらします
入院精神科での制限的慣行の使用を減らすことを目的とした介入の適切に管理された評価の必要性が認識されています.

研究の目的:

精神科重症治療室 (PICU) での拘束力の使用を減らすための文化変化の介入の有効性を評価する.
特殊なスタッフの役割の実施後に介入 PICU と制御 PICU の間の抑制結果を比較する.

主な方法:

介入PICUには"制限介入の擁護者 (RRIA) "という専用の役割が設けられた.
RRIAは,拘束手順に関する多学科チームに直接のサポート,トレーニング,説明を行いました.
介入前の結果と介入後の結果の比較 (それぞれ19ヶ月) と定性面接を含む混合方法のアプローチが介入の影響を評価するために使用されました.

主要な成果:

介入PICUでは隔離,完全自制,スタンドホールの使用が大幅に減少しました.
定性的なデータは,介入PICUの安全文化におけるポジティブな変化を示した.
これらの文化的な改善は重要であり,影響力があり,直接RRIAの役割に起因すると見なされた.

結論:

病棟の慣行を変更することに焦点を当てた専門的な役割を実装することで,PICU内の安全文化を高めることができます.
この結果は,制限的慣行を減らすための標的型介入の効果を裏付けています.
PICUでの拘束力の使用を減らすために設計された介入のさらなる制御された評価は正当化されています.

キーワード:

医療の質の向上インシデント報告患者の安全患者中心のケア安全文化

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