探討影響內科病房病人身體約束後發生不良事件之預測因子

Predictors of Adverse Events Following Physical Restraint in Internal Medicine Ward Patients: An Exploratory Study

背景：身體約束為內科病房常見照護方式，目的是預防病人自拔管路與躁動等不良事件。然而臨床上這些事件仍可能發生，因此需深入探討影響因子。
目的：本研究旨在探討內科病房中接受身體約束之病人，其人口學特性、情緒狀態、社會支持與醫療相關因素，與約束期間不良事件（自拔管路與躁動）之間的關聯性，並從中找出身體約束後不良事件之預測因子，以供臨床決策與處置之參考。
方法：本研究為回溯性研究（retrospective study），採病歷資料收集方式，以卜瓦松迴歸分析探討住院病人約束後發生不良事件（拔管次數與躁動次數）之預測因子。預測因子包含人口學特性、情緒、社會與醫療等四大因素。研究對象為2022年1月1日至2023年2月28日期間入住台北市某區域教學醫院內科病房、年滿20歲並接受身體約束之病人，納入樣本數共100位。
結果：本研究共納入100位內科病房約束病人之資料進行分析，結果顯示約束中發生拔管次數的顯著預測因子包括：（1）陪病者為外籍看護（B = 0.81, p = .01）；（2）約束中情緒欠穩（B = 1.36, p = .02）；（3）約束中拔管次數越多（B = 0.61, p = .02）；（4）約束前躁動次數越多（B = 1.13, p = .04）。約束中發生躁動的顯著預測因子包括：（1）服用非類固醇抗發炎藥（B = 1.27, p < .01）；（2）躁動時有給予藥物（B = 0.75，p < .01）；（3）約束原因為協助治療（B = 0.63, p = .04）；（4）約束前拔管次數越多（B = 0.55, p = .02）；（5）約束前躁動次數越多（B = 1.44, p = .02）。
結論：為降低身體約束後之不良事件，本研究建議：優先安排家屬陪病；約束期間定期評估病人情緒狀態；針對使用非類固醇類抗組織胺藥物及鎮靜藥物的病人，建立藥物使用警示機制，並密切監控用藥反應；強化約束前溝通與非藥物介入措施。

Background: Physical restraint, commonly used in medical wards to prevent self-extubation and agitation, sometimes fails to achieve one or both of these objectives. Thus, the factors contributing to the occurrence of self-extubation and agitation under restraint require further exploration.
Purpose: This study was developed to identify the predictors of two types of adverse events (unplanned device removal and agitation) among hospitalized patients under physical restraint in medical wards.
Methods: This retrospective study analyzed the medical records of 100 patients aged≥20 years who had been physically restrained in a regional teaching hospital in Taipei between January 2022 and February 2023. Poisson regression was used to examine predictors across the four domains of demographic, emotional, social, and medical factors.
Results: The significant predictors of extubation during physical restraint identified in the analysis included having a foreign caregiver (B = 0.81, p = .01), emotional instability (B = 1.36, p = .02), a history of extubations during restraint (B = 0.61, p = .02), and a history of agitation episodes before restraint (B = 1.13, p = .04). Predictors of agitation during restraint included use of non-steroidal anti-inflammatory drugs (B = 1.27, p < .01), medication use during agitation (B = 0.75, p < .01), restraint for treatment purposes (B = 0.63, p = .04), and a history of extubations (B = 0.55, p = .02) or agitation (B = 1.44, p = .02).
Conclusion: Based on these findings, recommendations for reducing adverse events following physical restraint include prioritizing family caregivers, receiving routine emotional assessments, monitoring medications, and enhancing communication and non-pharmacological strategies prior to restraint.