Cooling the hot climate of aggression and assault: Creating a safer environment in mental health

Purpose:
Creating an environment that is safe for everyone is a goal for all mental health units; how to do this is the challenge. This presentation discusses how using a multifacted interdisciplinary team with a variety of approaches can help create a culture that supports safety for all.

Significance:
Assaultive and aggressive behaviors lead to poor outcomes, workers compensation, injured staff and patients, poor staff relations. In an effort to have respect for all, and decrease these events, a team was created to lead the way to cool the 'hot' climate.

Strategy and Implementation:
Based on increases in assaults and aggression, an interdisciplinary team was created to combat the 'hot' climate. Involving the top clinical and administrative leaders were critical to the success of the program. The steering committee is comprised of 3 subteams:- policy reviews, milieu assessment, medication management; in addition, each of the 7 units conducted unit-based assault/aggression reduction meetings. Everyone, including each front line staff member was kept abreast of the daily climate so we could each make a positive impact. Other strategies included: daily reviews, use of peer review through TRIPS (Traveling review and intervention process)teams, improved communication, adopting a theory-based nursing philosophy of caring (Boykin & Schoenhofer.

Evaluation:
A decrease in assaults and aggression: 25% decrease in physical altercations, 25% decrease in injuries related to altercations and a 47% increase in the number of staff that rate our attention to safety as excellent or very good (AHRQ Patient Safety Culture survey.

Implications for Practice:
Staff satisfaction with safety is high; a better working environment has been created for both staff and patients. Staff education has been important as has the involvement of all hospital leadership.