Background Violent behaviour displayed by hospital patients that are a physical and personal threat to patients, visitors and staff is an emergency situation. Aim To evaluate medications used to manage violent behavioural disturbances; to explore patients' antecedent characteristics; and to assess concordance with hospital guidelines. Method Retrospective analysis (March 2008 to August 2009) of a convenience sample of hospital patients who displayed violent behaviour requiring an emergency response. Patient data were extracted from case notes and the Australian Incident Monitoring System, and included baseline demographics, medication used during admission, details of the behavioural disturbance and outcomes of the emergency response. Results Of the 28 patients analysed, 23 (82%) were male. Mean age was 81.5 years and 50% were aged 80 to 89 years. 17 (61%) patients were admitted for cognitive decline and 24 (86%) had a history of neuropsychiatric disorders. Clonazepam was the most frequently used drug and the intramuscular route was the most popular mode. Patients with poorly controlled pain were more likely to display violent behaviour (p < 0.01). Initiating antipsychotics or dose increases during admission was significantly associated with multiple violent episodes (p < 0.001). Opioids were most likely to be charted before a violent episode (n = 10; 36%) and ceased after an episode (n = 5; 18%). Concordance with hospital guidelines was observed in 18 (64%) cases. Non‐concordance with hospital guidelines was not predictive of multiple violent episodes. Conclusion Better assessment of at‐risk patients and early intervention are required. Concordance with hospital guidelines was low. Effective implementation, monitoring and adjustment of protocols used in emergency responses require interdisciplinary collaboration.
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