Purpose:  The threat of assault and personal injury evokes anxiety, fear and potential job dissatisfaction for in-patient psychiatry staff.  Patients at high risk for acting out and potential assault can include patients presenting with: Alzheimer’s or dementia, alcohol or substance abuse, acute psychotic disorders and agitated mania.  The inherent threat of assault and injury constitutes the need for a systematically applied quality improvement process to identify potential risk factors and reduce incidents. The principles of evidence-based practice (EBP) were utilized to guide the development of a best practice model for preventing assaults. 

Description of how the session will provide relevant and current knowledge:  This presentation outlines the steps of Rosswurm and Larrabee’s model of Evidence-Based Practice and highlights the program developed. A brief overview of the research on assault and staff safety, and steps designed to lower the rate of assaults and staff injuries is provided.  These steps include:  a) nonviolent Crisis Prevention Intervention (CPI) staff training, b) adoption of a standard of care addressing risk for injury to self and others (to include a “Risk for Injury Flow Sheet” and Incident Report form), c) utilization of a multidisciplinary plan of care (to include physician input) which is reviewed and updated daily, d) budgeting for a staff position to serve as a security presence on the unit, e) creation of a mechanism for staff involved to immediately debrief incidents by reviewing what occurred, evaluating intervention techniques (designed to enhance staff performance) and, if necessary, modify the patients plan of care f) initiation of a Safety Security Committee which reviews all assaults/injuries and refines prevention protocols.  A case example of a patient “acting out” scenario, including diagnostic considerations will be provided as a handout.   

Summary of the presentation:  The poster will provide an overview of how EBP principles were applied to reduce assaults on an in-patient psychiatric unit.  The Rosswurm and Larrabee Model of EBP will be linked to the real-world experience of using the steps of EBP to generate a best-practice model.  The poster presentation will offer practical examples of quality improvement processes and tools that are designed to continually improve staff performance, patient care, and the patient care environment. 

Implications for practice:  The presentation will depict the use of an EBP process that can used to address a large variety of problematic situations that occur in the course of caring for patients.  Templates for tool and process development to support a reduction in assaults may be used across patient care settings.