Implementation of Aggression Screening in a Child and Adolescent Psychiatry Unit

Abstract

Problem: Adequate management of patient aggression within psychiatry proves to be difficult. Seclusion and restraints are often used to help manage aggressive patients. The American Psychiatric Nurses Association released a statement endorsing efforts aimed at reducing seclusion and restraint events. This unit has reported an increase in the use of seclusion and restraint events over a one year time period. Purpose: The purpose of this quality improvement (QI) project is to implement the Dynamic Appraisal of Situational Aggression-Youth Version screening tool in a child and adolescent inpatient psychiatric unit for patients ages eight to seventeen to decrease the use of seclusion and restraints. Method: This project was implemented over a 15-week period from August-December 2022. The DASA-YV screening tool was integrated into the electronic health record. The multidisciplinary team developed guidelines for interventions for each scoring category of screening. Each registered nurse was trained on the use of DASA-YV and the interventions associated with the level category. Screenings were conducted by the registered nurse within 24 hours of patient admission to the unit. Results: Baseline data were collected for seclusion and restraint events for 8 weeks pre-implementation. The numbers of seclusion and restraint events ranged from 0-5 over the 8 week period. Week 2 of implementation revealed 13 seclusion and restraint events. After week 2, seclusion and restraint events ranged between 0-5. Psychiatric nurses screened 86% of newly admitted patients throughout implementation. Compared to 2021, seclusion and restraint events decreased by 26%. Conclusions: Findings indicate that this practice change did not meet process goals for each week of implementation. Through provision of feedback and adjustment of strategies and tactics, compliance improved which reflected acceptance by staff. It is anticipated that over time, seclusion and restraint events will continue to decrease. DASA-YV is a validated screening tool that may assist in identifying aggressive patients and reducing seclusion and restraint events in other inpatient child and adolescent units. Early detection may aid in utilizing interventions to eliminate use of seclusion and restraints.