Mitigating Pediatric Inpatient Aggression: A Quality Improvement Initiative

Area of Science:

• Healthcare Quality Improvement
• Patient Safety
• Pediatric Healthcare

Background:

• Patient aggression in healthcare settings is a growing concern, leading to significant psychological trauma and lost productivity.
• Underreporting of workplace violence incidents in healthcare limits the development of effective harm reduction strategies.
• Pediatric inpatient aggression poses unique challenges requiring targeted interventions.

Purpose of the Study:

• To increase the reporting of safety events related to pediatric patient aggression by 10% over 12 months.
• To address gaps in the care of pediatric inpatients exhibiting escalating behaviors.
• To foster a culture of employee safety within the healthcare environment.

Main Methods:

• An interdisciplinary quality improvement team implemented a multi-faceted intervention strategy.
• Interventions included staff knowledge surveys, updated care guidelines, electronic medical record enhancements, a patient aggression screening tool, and an online education module.
• Primary outcome was the number of reported safety events; compliance with the aggression risk screening tool was a process measure.

Main Results:

• Reporting of safety events related to aggressive patients increased from <1.0 to 3.0 events per 1000 patient days.
• Statistical process control charting indicated special cause variation in reporting rates.
• Compliance with the pediatric aggression risk screening tool improved significantly, approaching 90%.

Conclusions:

• A comprehensive approach involving various interventions can effectively improve the reporting of workplace violence events.
• Enhanced reporting mechanisms contribute to a safer environment for healthcare employees.
• Quality improvement initiatives are crucial for managing and mitigating pediatric inpatient aggression.