Improving Safety in the Pediatric Emergency Department through Early Violence/Aggression Assessment

Abstract

Problem & Purpose: The Pediatric Emergency Department (PED) setting is not exempt from workplace violence (WPV). Frontline staff in the PED have identified concerns around a rise in WPV incidents over the last few years. From January 1, 2018 through March 5, 2019, this PED saw 2,058 mental/behavioral health visits. Of mental/behavioral health focused visits, 79 visits (3.8%) resulted in coercion in the form of intramuscular antipsychotic or anxiolytic medication administration related to aggressive or violent behavior. The purpose of this project was to implement and evaluate the effectiveness of a violence risk assessment tool in a PED setting. Methods: This quality improvement (QI) project involved training PED Psychiatric RNs in an urban, academic PED on the use of the Pediatric Violence/Aggression Assessment Tool (PVAAT) to screen patients aged 8 years-17 years presenting with a chief complaint related to acute mental/behavioral health concerns. The P-VAAT score assisted the RNs to determine preventive or early intervention measures to implement in the interest of patient and staff safety. Results: Of 297 eligible patients, 152 were screened resulting in a 51.1% tool completion rate. One hundred twenty eight patients scored as ‘Low’ risk, 12 scored as ‘High’ risk, and 12 as ‘Moderate’ risk. Of those that scored ‘High,’ five exhibited violent/aggressive behavior during their encounter. Of these five, four required a short-term physical hold with intramuscular anxiolytic/antipsychotic medication administration and one was placed in seclusion. Another patient in the ‘High’ group was de-escalated and cooperative taking oral anxiolytic/antipsychotic medication. Conclusion: Observed and reported feedback through personal interactions with RNs support the ease of use and effectiveness of the Pediatric Violence/Aggression Assessment Tool (PVAAT). RNs report early identification of risk for violence allows for better preparation and safety in potential outbursts. Opportunity exists to expand this QI project with a focus on the use of this tool to include medical patient as well as building the P-VAAT into the electronic medical record system.