Reducing Patient Aggression Through a Nonviolent Patient De‐escalation Program: A Descriptive Quality Improvement Process

Abstract

Background Patients commonly display aggressive and violent behaviors toward nursing staff, contributing to severe consequences. Healthcare institutions must develop and implement systems addressing this global safety problem. Aim To improve clinical practice safety for inpatient acute care settings by providing healthcare teams throughout a large academic medical center with a Behavioral Emergency Response Team (BERT) program, that is, a system for reporting and de‐escalating aggressive patient encounters. Methods This descriptive quality improvement process took place within two inpatient acute care departments using simulation‐based training, patient safety rounds, and a BERT activation system. Participant groups included nursing personnel who completed a baseline survey (n = 302), telecommunication dispatchers (n = 20), BERT responders (n = 78), and bedside nursing staff (n = 43) recipients of BERT program resources. Methods included a baseline questionnaire, pre‐ and post‐intervention surveys, formal reports of aggressive patient encounters, documentation from patient safety rounds, and records of activated BERT responses. Data analysis included descriptive statistics, boxplots, and the Wilcoxon signed‐rank test. Results This project mitigated patient aggression episodes by successfully designing and implementing an evidence‐based BERT program. Findings suggested bedside nursing program participants felt more confident and capable of managing aggressive patient behaviors. A strong partnership between security officers and nursing staff limited the risk of harm to clinical staff by identifying and intervening with 41 potentially aggressive patients. Finally, formal reports of patient aggression episodes did not increase during this project, which may have indicated early prevention and detection of aggression while reflecting the broader problem of aggression under‐reporting in nursing. Linking Evidence to Action Healthcare organizations need to have robust systems to manage aggressive patient encounters. Comprehensive strategies for managing patient aggression include simulation‐based training, the use of BERT responders, and a strong partnership between nursing and security officer teams.

Behavior Intervention Response Team: Piloting an Effective Means to Manage Patient- and Family-Disruptive Behaviors

“…A multidisciplinary team can respond to and prevent incidents of workplace violence while supporting healthcare team members as well as patients, families, and other visitors (Strickler, 2018). Numerous organizations have worked to develop simulation-based training (Brown et al, 2018) for behavior emergency response teams (Christensen et al, 2021; Zicko et al, 2017). These teams take a broad-based approach to prevention, training, and reduction of behavioral emergencies and assaults.…”

Why nurses do not report patient aggression: A review and appraisal of the literature

“…Clinical workplace settings can be dangerous for nurses, and over the past decade, health care workers have seen alarming increases in violence‐related injuries (The Joint Commission, TJC, 2021). It is progressively common for patients in health care workplace settings to perpetrate acts of verbal and physical aggression towards nursing professionals (Christensen et al, in press; Geoffrion et al, 2020). Patient aggression can be categorized as type II workplace violence (Huang et al, in press; Pompeii et al, 2016) and includes acts of violence: an extreme form of aggression (Allen & Anderson, 2017).…”