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The objective of this retrospective study was to investigate the effectiveness of preventive measures taken against escape from the ward or hospital. We compared two groups of brain injured patients who were admitted before and after preventive measures were taken. The number of patients included in this study was 140 for the before group and 107 for the after group. After preventative measures were taken, the percentage of patients who successfully escaped from the ward was reduced from 22.1% to 7.5% and the percentage of patients who mounted unsuccessful escape attempts increased from 7.9% to 15.0%. This indicates that our preventive measures worked effectively. On the other hand, the percentage of patients who successfully escaped from the hospital remained the same. This revealed a limitation of our measures. An analysis of ten patients who escaped from the hospital revealed the characteristics of the high-risk patients: they all could move independently on foot or with a wheelchair. Five escapes had severe cognitive dysfunction with disorientation and memory disturbances. However, the other five patients had only relatively mild cognitive problems. (Jpn J Rehabil Med 2003; 40: 369-373) 要 旨: 当院で は2002年1月 よ り, 脳損傷 者 の離 院 ・離 棟対 策 として, (1)「離 院防止 マニ ュ ア ル」の 作成 とそれ に沿 った職員 訓練, (2)ア クセ ス コー ル設置, (3)ココセ コムの装 着, (4)リ ス トバ ン ドの装 着, (5)名前 シール の衣服 貼 り付 け, (6)捜索 用個人 特徴 書 の作成, (7)病 棟 出入 り口 の扉 の設置, な どを行 っ て い る. 調 査対 象 は, 2002年1~12月 に当 院入 院 した脳 損 傷 者107 名 と各 種対 策 が行 わ れ る前 の2000年7月 ~2001年12月 の 間 に同一 病棟 へ入 院 した脳 損 傷 者 140名. 対 策 前後 で, 離 棟 未遂 群 が7.9%か ら15.0%へ 増 加, 離棟 群 が22.1%か ら7.5%へ 減 少 し, 離 棟予 防 につ いて は一 定 の効果 をあ げた. 一 方で, 離 院群 の割合 は減 少 して お らず, 離 院対 策 の ココセ コムが, 簡単 に取 り外 せ て しま う とい う問題 が明 らか に なった. 開放病 棟 で認 知 障害者 の管 理 を行 う場 合, 家族 へ各 種対 策 につ いて十分 説 明 し, 対策 に限界が あ る こ との理 解 も得 た上 で, 入 院 の同意 を得 る必 要が あ る. (リハ 医学2003; 40: 369-373)

Brain Injured Patients at Risk of Escape from the Ward or Hospital: A Comparison of Patients before and after Measures against Escape were Taken