Development, implementation and evaluation of a process to recognise and reduce aggression and violence in an Australian emergency department

Abstract

Objective: In 2018, we developed and implemented a novel approach to recognition and response to occupational violence and aggression (OVA). It included routine use of the Brøset Violence Checklist for all ED patients integrated with a scorebased notification and response framework. The present study evaluated the impact of the new process on staff knowledge, perceptions and confidence regarding OVA in ED and the rate of security events related to OVA. Methods: The present study was conducted in a metropolitan hospital ED in Australia. Evaluation was by online before and after survey of nursing staff, point prevalence study of risk classification and comparison of OVA-related events involving security in the year before implementation and the year after the programme was embedded. Results: One percent of patients were assessed as high violence risk with a further 4% at moderate risk. The introduction of the Brøset Violence Checklist increased documentation of violence risk assessment. It also improved staff perception of organisational support and awareness of behaviours associated with the risk of violence. There was a statistically significant reduction in unplanned OVA-related security responses (relative risk 0.75, 95% confidence interval 0.62-0.89). There was also a statistically significant shift to proactive management through early detection and intervention (relative risk 2.22, 95% confidence interval 1.85-2.66). Conclusion:A process including routine OVA risk assessment and a notification and response framework reduced unplanned security events due to OVA and increased staff confidence in recognition and management of OVA. This approach may be suitable for use more broadly in ED.

Validity and reliability of the novel three‐item occupational violence patient risk assessment tool

“…The Violence Risk Screen Decision Support was a digital single‐item screen prompt at triage if patients are at risk of violence based on the nurses' subjective perceptions of risk (Daniel, 2015 ). The Broset Violence Checklist was primarily designed to capture behaviours of inmates with mental illness in a maximum security unit (Linaker & Busch‐Iversen, 1995 ) and has been used in EDs with some success (Partridge & Affleck, 2018 ; Senz et al, 2020 ). Items in the Broset Violence Checklist (Linaker & Busch‐Iversen, 1995 ) suggest that some form of violence must have already occurred to trigger an alert, that is, boisterous behaviour, threats and attacking objects, so its use in EDs negates the purpose of OV prevention through risk assessment.…”

“…For example, ED nurses believe that OV‐specific patient risk assessment could provide them with the opportunity to pre‐emptively identify patients who could perpetrate violence enabling staff to undertake appropriate precautions and instigate early interventions (Cabilan et al, 2020 ). Indeed, several studies exploring the impact of risk assessment affirm that a routine patient risk assessment could reduce OV incidents, negate the need for coercive restraints and/or limit detrimental impacts of OV in EDs (Daniel, 2015 ; Kling et al, 2011 ; Senz et al, 2020 ; Sharifi et al, 2020 ).…”

“…A novel tool that can be initiated in the ED and adaptable to the inpatient setting presents an opportunity to have a standard OV risk assessment tool. When this is achieved, the benefits afforded by risk assessments—such as mitigation of OV incidents, coercive restraints and negative impacts of OV (Daniel, 2015 ; Kling et al, 2011 ; Senz et al, 2020 ; Sharifi et al, 2020 )—could be impactful and consistent.…”

Interventions for Workplace Violence Prevention in Emergency Departments: A Systematic Review

“…The use of risk assessment tools for screening patients was also suggested by ED staff in a survey on interventions for occupational violence [39]. In an Australian ED, the implementation of such a tool to identify 'at risk' patients, including a response framework, significantly reduced unplanned violence-related security responses [42]. Cabilan et al [39] developed a framework for planning occupational violence strategies.…”

Interventions to Address and Prevent Violence Toward Health Care Workers in the Emergency Department

“…EDs are considered high-risk areas with incidences of violence against HCWs reported to range between 60% and 90%. 3 Although WPV frequently occurs in the ED, few affected individuals report it, and fewer seek help. 4,5 Causes of violence and aggression can vary and are not always clear.…”