Creation of a Violence Risk Assessment Tool: A QI Project

Purpose:
To assist nursing staff identify patients who pose the highest risk for violence early in the admission process, intervene promptly and maintain ongoing clinical re evaluation. Ultimately, provide a safe and therapeutic milieu to both, patients and staff.

Significance:
Aggression and violence by mental health patients has become an increasing concern for the safety and wellbeing of staff working with this population. Furthermore, a history of violence has been demonstrated to be one of the strongest predictors of future violence.

Strategy and Implementation:
This quality improvement project was proposed and approved by Behavioral Health Collaborative Practice Committee, the Psychiatric Medical staff and Unit Practice Council. The tool was approved by Orlando Health Safety and regulatory committees and it was successfully launched on the patient electronic record April 2012. 1. A systematic review of the literature was performed to identify risk factors of violence in the acute care setting. 2. A violence risk assessment tool was designed in a question format using the ten most reliable and accurate risk factors from theV-RISK-10 risk assessment which have been proven to be the highest predictors for violence. 3. Educational plan was developed and implemented. 4. The tool was piloted in 80-bed inpatient psychiatric units from November 2011 to January 2012. 5. Frequent feedback was gathered from nurses and Behavioral Health committees which helped refined the tool and accommodate for further education on identified knowledge gaps.

Evaluation:
A month data from pre and post implementation of the tool and six months later were measured and compared. Measures and Results: Patient to Patient Assaults in Oct/Nov 2011 were 1/1; in Apr 2012 was none (0). Patient to Staff Assaults in Oct/Nov 2011 were 3/0; in Apr 2012 were none (0)

Implications for Practice:
Creating and implementing this evidence-based violence risk assessment tool has demonstrated significant improvement in the delivery of qualitative and safe health care practices. However, collaboration among health care providers is fundamental in the provision of care to a high risk population.