Violence risk assessment tool and response algorithm
Suzanne M. Gervase, MSN, RN, CNE, CEN; Joseph Nadzady, RN, BSHA, PHRN; Jill Althoff, MA, RN, PHRN, CEN, CHEP, CHSP
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Session E presented Friday, September 28, 10:00-11:00 am
Purpose: The purpose of this process improvement project is to integrate assessment, violence risk stratification, and stage-related interventions to provide an early warning system that integrates evidence-based interventions with appropriate risk level, promoting a proactive, coordinated approach to managing violent behavior.
Design: A 30% increase in violent patient activity from 2012 to 2015 and a prevalence of violence that is eight times higher than the national average prompted Waynesboro Hospital Emergency Department to review existing violence prevention strategies through a multidisciplinary quality improvement initiative.
Setting: This project's setting includes two rural hospitals; a 12-bed emergency department in Waynesboro, PA and a 28-bed emergency department in Chambersburg, PA
Participants/Subjects: This multidisciplinary project includes representation from Security, Emergency, Education, Patient Safety and Quality Departments.
Methods: Utilizing the Lean systematic approach, the group identified three critical themes: create standard work to include role clarification, expectations, and resource availability; create situational awareness about protocols for handling violent patients; create a better understanding of thresholds which may dictate when additional assistance is needed (Roca, Charen, and Boronow, 2016). Work groups were established to develop two key improvements. One group developed a risk stratification scoring system integrated within existing ED nursing assessments for behavioral health-, anxiety-, overdose-, and substance abuse- related complaints. A numeric value is assigned to assessed behaviors, generating a raw score that is stratified into low, moderate, or high risk for violence categories. This triggers an automated visual on the ED's patient tracker to provide staff an early warning signal for individual violence potential and overall departmental risk. The second group developed a stage-related response plan that identifies roles and responsibilities, incorporates evidence based interventions, and recommends pharmacologic delivery methods (Emergency Nurses Association, 2016).
Results/Outcomes: Validation of the risk assessment tool is instrumental for the project's successful implementation. A three-month retrospective chart review completes phase one of an ongoing validation study. Preliminary data analysis is pending. However, raw trends have emerged and will drive the staff education process necessary to implement prior to stage two of the study, the final data collection process. The educational barriers data collectors identified during the chart review includes inconsistent assessment practices, general misunderstanding of behavioral health related terminology, and incomplete documentation practices. In the interim, process improvement efforts are paying off. Between 2016 and 2017, the amount of security calls for disorderly conduct increased 12%, while calls for Code Green (active violent situation) decreased 16%. This means staff are proactively identifying a potentially violent situation, using resources wisely, and intervening appropriately to diffuse the situation.
Implications: Effective implementation of this process and associated tools establish early identification of violence potential, enabling efficient and appropriate use of hospital resources that may reduce the amount of violent occurrences in the emergency department; maintain a safer environment for patients, families, visitors, and staff; improve staff morale related to the physical/emotional challenges of intervening with violent patients; reduce severity/incidence of staff injuries and associated worker's compensation costs; and reduce potential liability through the reduction of and severity of patient/visitor injuries (US Department of Labor, 2015).
Emergency Nursing 2018. Held at David L. Lawrence Convention Center, Pittsburgh, Pennsylvania, USA
|Review Type||Abstract Review Only: Reviewed by Event Host|
Violence Risk Assessment;
Managing Violent Behavior
|Name||Emergency Nursing 2018|
|Host||Emergency Nurses Association|
|Location||Pittsburgh, Pennsylvania, USA|
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