鱼骨图法分析精神病患者出走的原因

摘要

目的 分析精神病患者出走的原因,为防范精神病患者出走提供对策依据.方法 通过查看各病区上报的不良事件报告及原因、查阅病历等分析26例发生出走不良事件的精神病患者的相关资料,综合、分类后绘制鱼骨图.结果 精神病患者出走发生的原因可概括为管理因素、患者因素、工作人员因素和环境因素,防范对策包括加强出走高危患者的看护和病情观察、强化工作人员的风险防范意识、应用"五常法"做好病区安全管理及保证持续安全质量控制.结论 鱼骨图用于精神病患者出走原因的分析简便实用,为防范精神病患者出走提供了对策依据,为进一步实现持续安全质量改进提供了有力保证.%Objective To analyze the eloping reasons of hospitalized psychiatric patients so as to provide the basis for preventing the elopment of psychiatric patients. Methods A retrospective analysis was conducted on the relevant data through consulting the adverse event reports from different wards as well as eloping reason analysis and medical records to design a fishbone diagram. Results The eloping reasons included patients' condition, staff factors, environmental factors and management factors. Preventive measures included strengthening the nursing and observation of the disease of high-risk eloping patients,strengthening staff's awareness of risk prevention and applying five-elements method to ward management and ensure the continued safety and quality control. Conclusion Fishbone diagram is convenient in analyzing the eloping reasons of hospitalized psychiatric patients,which provides a basis for preventing eloping psychiatric patients and ensuring continued safety and quality control.