行動制限に関する一覧性台帳を用いた隔離・身体拘束施行量を示す質指標の開発

Development of Quality Indicators to Monitor Seclusion and Restraint of Patients on the Basis of Official Records Maintained at Psychiatric Hospitals

抄録

　本研究の目的は，行動制限に関する一覧性台帳から簡便に算出できる隔離・身体拘束の施行量を示す質指標を開発し，その有用性を検討するとともに，その指標を用いて実態を明らかにすることである。調査対象となった27の精神科救急入院料病棟を有する施設から，一覧性台帳と施設特性に関する調査票を回収した。先行研究を精査したうえで開発した指標によると，隔離と身体拘束の「月当たり平均日数」は12.5日，13.2日，「施行割合」は9.0％，4.3％であった。指標の示す数値は施設別に分布の幅があり，当指標と施設特性とには相関が認められた。一覧性台帳から得られる指標をモニタリングに用いることができると考えられた。

　This study aimed at developing and assessing the feasibility of quality indicators for seclusion and restraint (S/R) of patients on the basis of the current S/R records mandated by the Ministry of Health, Labour and Welfare. We developed indicators on the basis of review of literature and examined the S/R records and facility characteristics in 27 hospitals with psychiatric emergency care wards. According to the indicators, the average duration for a period of 1 month was 12.5 days in the case of seclusion and 13.2 days in the case of restraint, while the rates of S/R days by patient-days were 9.0% and 4.3% respectively. These indicators, i.e., the average duration of seclusion or restraint in a month and the rates, varied widely among hospitals and were associated with facility characteristics. Our results suggest that these indicators can be used to monitor S/R use and improve the quality of psychiatric care.