Violence: Not in Your Job Description

Purpose:
Patient on nurse violence is growing concern at all levels of care. Holy Cross Hospital has developed a multidisciplinary strategy to reduce the number of violent events and to protect patients and staff

Significance:
Initially undocumented, the pervasiveness of the violence problems was greater than perceived. We found that violent patients may be in alcohol withdrawal, have ICU delirium or be acting out in panic due to physiological needs such as desaturation. Often, a combination of factors contributed

Strategy and Implementation:
A group of advanced practice nurses reviewed data from each event to establish a baseline of WHY violent events were occurring. With this new knowledge, we implemented the following : Simplified and revised policies. Education at three levels of specificity trained employees in violence prevention. Implementation of three levels of alert; saving the team response for the most serious events. Intensive care physicians assist on an as needed basis. Security job descriptions altered to allow a more robust response. The acute violence response team was expanded. Every event is reviewed and documented so trends and best practices can be established. Very violent patients are documented in the medical record so as to be easy for future caregivers to be aware of the violent history. Roll out of program to all levels of employees Implement a history of violence guide for future caregivers who will encounter this patient

Evaluation:
HCH has focused on reducing risk of violence by streamlining processes and managing patients appropriately. Our process is newly implemented, effectiveness will be monitored. Initial observations include high staff satisfaction and increased teamwork among nurses and security.

Implications for Practice:
Analysis of reasons for violent behavior allows for prevention education at levels appropriate to risk. Staff can often prevent aggressive outbursts. Having distinct levels of alert provides strong communication with security and hospital administration for rapid action in times of crisis