Implementation of a Risk for Violence Tool to Reduce Patient Violence
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Abstract
Problem & Purpose: The successful management of aggression and violence from patients presents a significant challenge in inpatient psychiatric units. In 2023, at a 36-bed inpatient behavioral health unit recorded 127 patient-related violence events. This quality improvement initiative was developed to implement a violence assessment tool to predict an impending violence event, promoting early identification management. Methods: Thirty behavioral health staff nurses were trained on using the Broset Violence Risk Assessment tool (BVC), which assesses six objective violence behaviors. Once patients are identified as a risk for violence, early interventions are implemented to deescalate violence. The BVC was completed on each patient on admission and every shift over the intervention period of 15- weeks. Results: The structure goal of educating 100% of the behavioral health unit nurses on the use of the BVC and prevention practices was achieved using a PowerPoint presentation delivered in person and virtually. The process goal was to have all staff complete the BVC 100 % of the time on admission and every shift. Results show that 92% (n=3483) of BVC scales were completed. The outcome goal was to achieve a 10% decrease in patient-related violence incidences rates. Before implementation, there were 59 episodes of patient violence and 4 staff-related injuries. Since the project’s implementation 23 episodes of violence incidences were reported with no injuries to staff. Conclusions: Using the BVC to identify patients at risk for violence and implementing appropriate interventions reduces the incidence of patient violence through early recognition and prompt mitigation. Implications for nursing practice include establishing a standard against which to assess patients for potential violence, thus reducing patient violence and injuries to staff. The BVC provides staff with a quick method to screen patients.