Development and Implementation of an Emergent Documentation Aggression Rating Tool: Quality Improvement

Area of Science:

• Emergency Medicine
• Quality Improvement
• Patient Safety

Background:

• Workplace violence is a significant issue in emergency departments (EDs), posing risks to both patients and staff.
• A standardized ED-specific tool is crucial for consistent assessment of escalating behaviors, justifying interventions, and reducing the use of restraints.
• This project aimed to develop and evaluate an ED-specific tool for proactive identification and intervention with patients exhibiting escalating behaviors.

Purpose of the Study:

• To design, implement, and assess the feasibility of an emergency department-specific tool.
• To enhance nurses' ability to proactively identify and intervene with patients' escalating behaviors.
• To improve documentation of aggressive patient events and decrease the utilization of patient restraints.

Main Methods:

• A quality improvement design was employed.
• The Emergent Documentation Aggression Rating Tool was developed using evidence-based behavioral cues and successful intervention strategies.
• Nurses received training on the tool, and chart data were collected from August 2018 to December 2019, supplemented by chart audits and just-in-time education.

Main Results:

• Adoption of the Emergent Documentation Aggression Rating Tool increased from 67.36% to 97.55% between Q3 2018 and Q4 2019.
• Post-implementation, a decrease in the percentage of restraints used was observed.
• There was a documented increase in the de-escalation of aggressive patient behaviors over time, with frequent escalations noted in patients with alcohol use, suicidal ideations, pain, or mental health issues.

Conclusions:

• The Emergent Documentation Aggression Rating Tool proved feasible for emergency nurses.
• The tool enables proactive identification and intervention for patients at risk of aggression or violence.
• Implementation of the tool supports improved patient safety and management of challenging behaviors in the ED.