特定機能病院の精神科病床における身体拘束に関する毎日の多職種カンファレンスの継続による効果—身体拘束率の低下と参加者の気づき

Effects of Continuing Daily Multidisciplinary Conferences about Physical Restraints in the Psychiatric Ward of an Advanced Treatment Hospital: Reduction in the Physical Restraint Rate and Clarification of Participants' Awareness

要旨

　目的：特定機能病院の精神科病床における身体拘束に関する毎日の多職種カンファレンスの継続による効果を，身体拘束率の低下および参加者の気づきという面から検証する．

　方法：2018年から2020年にかけて患者の身体拘束について議論するための多職種カンファレンスを毎日実施した．月毎の身体拘束率の推移を2次曲線回帰分析で，転倒転落率等の要因間の関連は相関分析で，身体抑制認識尺度で測定した身体拘束の必要性認識度は年毎の分散分析で解析した．自由記述には質的記述的分析法を用いた．

　結果：身体拘束率と身体抑制認識得点は有意に低下した．また身体拘束率と転倒転落率やThe Global Assessment of Functioning Scale（GAF）値との関連はなく，ナースコール呼び出し回数には正の相関がみられた．自由記述から【必要性の認識】【意識の変化】【効果と期待】【課題】が抽出された．

　結論：本試みは懸念事項を発生させずに身体拘束の低減に寄与した．また4個の気づきからは成果と課題が明確となった．

　Aim: To examine the effect of continuing daily multidisciplinary conferences about physical restraints on physical restraint rate and participants' awareness in a psychiatric ward of an advanced treatment hospital.

　Method: Daily multidisciplinary conferences were held to discuss physical restraint of patients during from 2018 to 2020. The monthly transition of the physical restraint rate is analyzed by quadratic curve regression analysis, the relationship between factors such as the fall rate is correlated analysis, and the degree of recognition of the necessity of physical restraint measured by the physical restraint recognition scale is analyzed by analysis of variance by years. The contents of free descriptions regarding participants' recognition were analyzed qualitatively and descriptively.

　Results: Physical restraint rate and physical restraint recognition score decreased significantly. However, there was no relationship between the physical restraint rate and the fall rate, and the Global Assessment of Functioning Scale (GAF). There was a positive correlation between the physical restraint rate and the number of nurse calls. From the free description, [recognition of necessity], [change in recognition], [effect and expectation], and [problems] were extracted.

　Conclusion: Daily multidisciplinary conferences contributed to the reduction of physical restraint without raising any concerns. In addition, the results and issues were clarified from the four awareness.