提昇急性精神科病房醫療團隊人員處理攻擊事件之能力

Enhancing the Capability of Medical Team to Manage Aggressive Events in Acute Psychiatric Wards

急性精神科病房病患攻擊事件不僅帶來人員損傷及物品破壞，導致個人身心傷害，甚而引發醫療糾紛，本專案主要以提昇醫療團隊處理攻擊事件之能力，期待降低攻擊事件發生及減低傷害，本單位2003-2004年突發事件中以攻擊事件佔最多約69%，其中發生攻擊事件27件，發生率0.09%，造成工作人員傷害率0.04%，分析原因為精神症狀、衝動控制力差、人際互動衝突有關，以攻擊評估量表進行篩檢、修訂暴力事件標準作業流程及護理常規、暴力演練、引導發洩體力、音樂放鬆、執行行為約定等措施，結果發現防範攻擊事件敏感度由56%提昇至100%；防範成功率達80％；攻擊事件發生率由0.09%下降到0.06%；工作人員傷害率由0.04%下降0.02%。顯現介入措施之有效性，所以提昇醫療團隊對攻擊事件敏感度及做好事先的防範，不僅可以降低醫療團隊人員之傷害，更可預防攻擊事件之發生，進而提昇醫療照護品質。

Incidences of violence in acute psychiatric ward can lead to not only facility destructions, but also mental, physical injuries and even medical disputes. As part of efforts to enhance medical team abilities to manage aggressive events, this study aimed to provide references for reducing both aggressive events and resultant damage. Over two-thirds (69%) of all unanticipated occurrences registered by our unit in 2003-2004 were classed as ”aggressive events”, i.e. there were 27 occurrences (0.09%) in which 0.04% resulted in staff injury. Events were mainly attributable to psychiatric symptoms, poor impulse control and interpersonal conflicts. For this study, we used several intervention methods, including categorizing patients by ”risk of violence” rank, revising the hospital's standard operation processes for handling violence and revising the nursing rules to enhance nurse skills at managingviolent events, countering patient violence, helping patients safely vent their anger and physical force, listening to relax music and conducting behavior modification. As a result, aggressive event prediction sensitivity increased from 56% to 100%, with successful prevention rates reaching 80%. The rate of aggressive event occurrence reduced from 0.09% to 0.06% and staff injuries decreased from 0.04% to 0.02%. Intervention methods employed were shown to be quite effective. If medical teams elsewhere enhanced their sensitivity and abilities to avoid aggressive events, injury and damages could be prevented and medical care quality enhanced.