Implementation of a Violence Checklist to Reduce Seclusion/Restraint on Inpatient Psychiatry

Abstract

Problem & Purpose: The effective management of patient aggression and violence presents a significant challenge to inpatient psychiatry units, with seclusion and restraint (S&R) commonly utilized to manage these crisis situations. The purpose of this quality improvement (QI) project is to implement an aggression/violence screening tool on an adult acute psychiatry unit to promote the early identification and management of potential for patient aggression/violence. Methods: The Brøset Violence Checklist (BVC) is an aggression/violence screening tool that assesses for six objective risk factors to establish the potential risk for patient aggression/violence. Aggression is defined as behavior carried out with the intent to harm another person, while violence is an extreme form of aggression that has severe harm (i.e. physical injury or death) as the end goal (Allen & Anderson, 2017). Staff nurses on a 15-bed high acuity inpatient psychiatry unit were trained on the use of the BVC and the least restrictive interventions to implement when a patient has been identified as at risk for aggression/violence. The BVC was to be completed on each patient admission on the unit over a 10-week period. Pre and post implementation surveys were conducted to assess the perception of staff nurses on their knowledge and skill set in the effective management of aggression/violence. Results: During the implementation period, the project leader provided training to 100% of staff nurses (n=43) under the adult inpatient psychiatry service on the use of the BVC to assess for early manifestations of risk for aggression/violence. Staff nurses screened 43% (n=38) of new patient admissions during the project implementation period. Staff nurses reported feeling that a screening tool would be useful in assessing for patient aggression/violence both pre and post implementation. Conclusion: Aggression/violence screening tools are an essential component in the effective management of patient aggression/violence and reducing S&R on inpatient psychiatry. While this QI project was successful in implementing the BVC to aid in the early assessment of patients at risk for aggression/violence, future QI projects should assess the role that least restrictive interventions play in reducing patient aggression and S&R events.