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

      Newton, Nakeia D.; Bode, Claire (2020-05)
      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.
    • Mitigating Workplace Violence Utilizing the Broset Violence Checklist

      Doyle, Karen E.; Jones-Parker, Hazel (2020-05)
      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.