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Recommended Citation
Olshan-Perlmutter M, Archer N, Roberge J, Edmunds K. Standardizing Behavioral Health Emergency Department Nursing Rounds Incorporating Diagnostic Sensitivity of the Dynamic Appraisal of Situational Aggression to Improve Workplace Violence. Quality Improvement poster presentation at Elevating Nursing Excellence: Purpose, Profession, Passion; Advocate Health Midwest Region Nursing Research & Professional Development Conference 2024; November 13, 2024; virtual.
Presentation Notes
Quality Improvement poster presentation at Elevating Nursing Excellence: Purpose, Profession, Passion; Advocate Health Midwest Region Nursing Research & Professional Development Conference 2024; November 13, 2024; virtual.
Abstract
Background
Workplace violence is a persistent threat in Emergency Departments, impacting both staff safety and patient care quality.
Local Problem
Despite advancements, it remains a pressing concern at the Atrium Behavioral Health Emergency Department as a rise in patient acuity has been observed as patients may exhibit symptoms and behaviors of aggression, agitation, and psychosis. Staff injuries have been on the rise in part due to an increase in patients requiring restraints.
Objective
The aim is to enhance patient and staff safety and reduce patient restraints by instituting purposeful nursing rounds and utilizing the Diagnostic Sensitivity of the Dynamic Appraisal of Situational Aggression tool.
Method
An interdisciplinary safety committee developed a tailored nursing round protocol specifically for psychiatric emergency patients, with rounds scheduled every 3 hours to align with staffing levels. The Dynamic Appraisal of Situational Aggression protocol underwent refinement shifting responsibility from Psychiatric Technicians to Nurses for a more thorough assessment of patient aggression risk. This involved a minimum of 3 assessments per shift, alongside an agitation protocol order set guiding de-escalation techniques and step wise intervention protocol based on Dynamic Appraisal of Situational Aggression scores.
Results
Analysis of data from July 2023 to February 2024 revealed significant post-intervention improvements. Child and adult restraint episodes decreased by 55.22% and 57.62%, respectively, while staff injuries saw a remarkable 68% reduction.
Conclusion
These findings highlight the effectiveness of integrating purposeful rounding and Dynamic Appraisal of Situational Aggression tool in mitigating workplace violence and enhancing safety. Furthermore, these interventions offer actionable strategies for addressing workplace violence in diverse medical settings. By expanding these interventions, such as in emergency departments and psychiatric units, facilities can improve patient care quality while maintaining safety, contributing to broader initiatives aimed at combat workplace violence in healthcare and medical settings.
References
1.B Aliohani, et al. Workplace Violence in the Emergency Depart.: A Systematic Review and Meta-Analysis. Public Health. 2021; 196:186-197.
2. Okundolor S, et al. Zero Staff Assaults in the Psychiatric Emergency Room: Impact of a Multifaceted Performance Improvement Project. Journal of the American Psychiatric Nurses Association.2021; 27(1) 64–71
3. Connor M, et al. L. Diagnostic Sensitivity of the Dynamic Appraisal of Situational Aggression to predict Violence and Aggression by Behavioral Health Patient in the Emergency Department. Journal of Emergency Nursing, 2020; 46(3): 302-308
Document Type
Poster
Publication Date
11-13-2024
Standardizing Behavioral Health Emergency Department Nursing Rounds Incorporating Diagnostic Sensitivity of the Dynamic Appraisal of Situational Aggression to Improve Workplace Violence
Background
Workplace violence is a persistent threat in Emergency Departments, impacting both staff safety and patient care quality.
Local Problem
Despite advancements, it remains a pressing concern at the Atrium Behavioral Health Emergency Department as a rise in patient acuity has been observed as patients may exhibit symptoms and behaviors of aggression, agitation, and psychosis. Staff injuries have been on the rise in part due to an increase in patients requiring restraints.
Objective
The aim is to enhance patient and staff safety and reduce patient restraints by instituting purposeful nursing rounds and utilizing the Diagnostic Sensitivity of the Dynamic Appraisal of Situational Aggression tool.
Method
An interdisciplinary safety committee developed a tailored nursing round protocol specifically for psychiatric emergency patients, with rounds scheduled every 3 hours to align with staffing levels. The Dynamic Appraisal of Situational Aggression protocol underwent refinement shifting responsibility from Psychiatric Technicians to Nurses for a more thorough assessment of patient aggression risk. This involved a minimum of 3 assessments per shift, alongside an agitation protocol order set guiding de-escalation techniques and step wise intervention protocol based on Dynamic Appraisal of Situational Aggression scores.
Results
Analysis of data from July 2023 to February 2024 revealed significant post-intervention improvements. Child and adult restraint episodes decreased by 55.22% and 57.62%, respectively, while staff injuries saw a remarkable 68% reduction.
Conclusion
These findings highlight the effectiveness of integrating purposeful rounding and Dynamic Appraisal of Situational Aggression tool in mitigating workplace violence and enhancing safety. Furthermore, these interventions offer actionable strategies for addressing workplace violence in diverse medical settings. By expanding these interventions, such as in emergency departments and psychiatric units, facilities can improve patient care quality while maintaining safety, contributing to broader initiatives aimed at combat workplace violence in healthcare and medical settings.
References
1.B Aliohani, et al. Workplace Violence in the Emergency Depart.: A Systematic Review and Meta-Analysis. Public Health. 2021; 196:186-197.
2. Okundolor S, et al. Zero Staff Assaults in the Psychiatric Emergency Room: Impact of a Multifaceted Performance Improvement Project. Journal of the American Psychiatric Nurses Association.2021; 27(1) 64–71
3. Connor M, et al. L. Diagnostic Sensitivity of the Dynamic Appraisal of Situational Aggression to predict Violence and Aggression by Behavioral Health Patient in the Emergency Department. Journal of Emergency Nursing, 2020; 46(3): 302-308
Affiliations
Atrium Behavioral Health Charlotte