使用行为干预小组（DEMEANOR）研究方案对住院患者进行的破坏性行为管理和预防：一项务实，整群，交叉的试验。,Trials

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使用行为干预小组（DEMEANOR）研究方案对住院患者进行的破坏性行为管理和预防：一项务实，整群，交叉的试验。
Trials ( IF 2.0 ) Pub Date : 2020-05-24 , DOI: 10.1186/s13063-020-04278-2
Jay Morrison ₁ , Michele Hasselblad ₁ , Ruth Kleinpell ₂ , Reagan Buie ₃ , Deborah Ariosto ₁ , Erin Hardiman ₁ , Stephen W Osborn ₁ , Christopher J Lindsell ₄ ,

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背景技术住院患者中的破坏性行为已成为临床人员安全关注的优先领域，并且也对患者管理和住院过程产生影响。据报道，对行为合并症患者进行主动筛查和干预可以减少某些情况下的破坏性行为，但尚未进行严格的研究。方法采用行为干预小组（DEMEANOR）研究对住院患者进行的破坏性行为管理和预防是一项实用，成组的交叉试验。每个月，行为干预小组都会由精神心理健康高级执业护士和临床社会工作者组成，并在需要时进行心理医生咨询，在美国田纳西州纳什维尔的范德比尔特大学医学中心的一个成年医学科和一个混合心脏科之间旋转。该团队在入院时利用包括全面图表审查以及如果需要的话进行简短访谈的方案对患者进行主动筛查，以寻找那些具有指示其潜在的心理障碍对其临床进展或潜在的危险因素的患者住院期间表现出破坏性，攻击性或自残行为的风险。一旦确定，该团队将提供旨在减轻这些风险的干预措施，教育和支持患者护理团队（护士，医生等），并协助非精神科人员管理需要行为保健的患者。入院和出院的患者均纳入研究。预期的入组患者约为1790名。这两个主要结果是（1）与患者的破坏性，威胁性或行为举止相关的客观指标的综合；以及（2）员工自我报告对他们具有处理破坏性，威胁性，或表现出行为。次要结果包括患者住院时间，患者护理人员（保姆）的使用以及单位护理人员的保留。讨论这项正在进行的试验将提供证据，证明前瞻性行为干预在预防成人住院患者中的破坏性，威胁性或行动性事件方面的有效性。试验注册ClinicalTrials.gov：NCT03777241。

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The Disruptive bEhavior manageMEnt ANd prevention in hospitalized patients using a behaviORal intervention team (DEMEANOR) study protocol: a pragmatic, cluster, crossover trial.

BACKGROUND Disruptive behavior in hospitalized patients has become a priority area of safety concern for clinical staff, and also has consequences for patient management and hospital course. Proactive screening and intervention of patients with behavioral comorbidities has been reported to reduce disruptive behavior in some settings, but it has not been studied in a rigorous way. METHODS The Disruptive bEhavior manageMEnt ANd prevention in hospitalized patients using a behaviORal intervention team (DEMEANOR) study is a pragmatic, cluster, crossover trial that is being conducted. Each month, the behavioral intervention team, comprising a psychiatric-mental health advanced practice nurse and a clinical social worker, with psychiatrist consultation as needed, rotates between an adult medicine unit and a mixed cardiac unit at Vanderbilt University Medical Center in Nashville, TN, USA. The team proactively screens patients upon admission, utilizing a protocol which includes a comprehensive chart review and, if indicated, a brief interview, seeking to identify those patients who possess risk factors indicative of either a potential psychological barrier to their own clinical progress or a potential risk for exhibiting disruptive, aggressive, or self-injurious behavior during their hospitalization. Once identified, the team provides interventions aimed at mitigating these risks, educates and supports the patient care teams (nurses, physicians, and others), and assists non-psychiatric staff in the management of patients who require behavioral healthcare. Patients who are both admitted to and discharged from either unit are included in the study. Anticipated enrollment is approximately 1790 patients. The two primary outcomes are (1) a composite of objective measures related to the patients' disruptive, threatening, or acting out behaviors, and (2) staff self-reported comfort with and confidence in their ability to manage patients exhibiting disruptive, threatening, or acting out behavior. Secondary outcomes include patient length of stay, patient attendant (sitter) use, and the unit nursing staff retention. DISCUSSION This ongoing trial will provide evidence on the real-world effectiveness of a proactive behavioral intervention to prevent disruptive, threatening, or acting out events in adult hospitalized patients. TRIAL REGISTRATION ClinicalTrials.gov: NCT03777241. Registered on 14 December 2018.

更新日期：2020-05-24

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