醫療暴力之樣態與防範

Recognition and Prevention of Hospital Violence

目的：醫療暴力不只對人身造成危害，也影響病人醫療，是病人安全的重要一環。台灣醫院常被視為公共開放場所，造成急診等各單位暴力威脅頻傳。本研究以單一醫院的暴力事件進行橫斷面研究，以了解暴力形態及解決之道。方法：研究以台北市某大型醫學中心，依據2011至2013年駐警隊工作日誌中暴力事件資料，逐案分析釐清事件發生的參數，包括個體、內容、時間、地點及誘發原因，進行基本的流行病學分析與統計。結果：三年共登錄912件暴力事件，發生集中在醫療服務的時段，地點以精神科病房（66.1％）及急診（12.3％）最多，近九成的暴力個體為病人本身，原因多由本身疾病引起（85.7％），且多需進行約束（82％），少數導致工作人員有明顯傷害（1.4％）。結論：多元漸進式的預防策略，包括早期通報機制，結合人員溝通及暴力應對訓練，配合制度透明化及硬體設施改善，將能減少暴力並提升職場安全。

Purposes: Prevention of violence in the hospital is an important part of patient safety because violence is not just harmful to personnel, but also interferes with medical care. Hospitals in Taiwan are usually regarded as freely-accessible public spaces, therefore violence is common not only in the emergency department, but other areas within the hospital. The current study attempted to define the epidemiology and develop policies to curb medical violence through a cross-sectional analysis of incident reports in a hospital. Methods: Security reports from a medical center in Taipei City were collected between January 2011 and December 2013, reports relevant to violence were reviewed, and the important factors, including who, when, where, what, and why, were identified and analyzed using fundamental biostatistics. Results: There were 912 cases in 3 years. Generally, the violent incidents occurred more frequently during business hours. Incidents were most common on psychiatric wards (66.1%) and in the emergency room (12.3%). Approximately 90% of violent perpetrators were patients, and the most common cause of violence was expression of an underlying disease (85.9%). Restraint of the perpetrator was required in the majority of situations (82%). Few incidents (1.4%) resulted in significant injuries. Conclusions: Multidisciplinary stepwise prevention strategies, including an early warning and reporting system, personnel training in communication skills and response to violence, transparent medical-related processes, and well-designed hardware and a safe environment, can prevent violence and improve occupational safety.