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Mitigating Workplace Violence Utilizing the Broset Violence Checklist

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2020-05
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Problem & Purpose: Workplace violence impacts all health care workers especially those working in behavioral health, emergency departments (EDs), and trauma centers. The Broset Violence Checklist (BVC) is an evidence-based, valid and reliable tool demonstrating high sensitivity and specificity with predicting potentially violent patients within a 24-hour period of assessment. The tool is available to nurses in the ED but is not widely used within the system due to a lack of procedure, education and monitoring of compliance. Methods: A quality improvement project developed a procedure to increase the use of the BVC. ED nurses and security personnel were trained and compliance with utilization of the tool was measured. A pre/post implementation survey was conducted to determine perceptions of workplace violence. A daily report detailing the use compliance and the BVC scores of each patient was automatically distributed to the emergency department and security leadership. The outcome measures are: (a) 90% of adult patients > 18 years old seeking treatment in the ED will be assessed for potential violence using the BVC during the intake and triage process and (b) overall incidences of workplace violence are reduced. Data were analyzed using descriptive statistics. Results: A convenience sample of 6,944 adults > 18 years old entered the ED in an academic acute care setting for evaluation and treatment in a 14-week period. Compliance with completion of the BVC pre-implementation was a mean of 74% and implementation of 67% (u = 1355, p = 0.014); 18 patients scored > 3 on the BVC (u = 188, p = 0.68). Conclusion: This quality improvement project illustrates it is difficult to improve compliance based on education alone. Enforcement of compliance with the procedure and assessment tool needs to be hard wired into the workflow of nursing and security personnel. It remains essential that hospitals incorporate violence assessment tools and strategies in the ED setting. As part of routine care, ED staff can use screening tools such as the BVC to identify people at high risk of violence. These tools can offer appropriate behavioral interventions to those who screen high on the assessment tool.

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