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A Quality Improvement Approach to Violence Reduction: Standardizing the Risk Identification Process
Fabio DeSouza1, Michael Bleich
1Department of Nursing, Central State Hospital, Petersburg, Virginia (Dr DeSouza); and The Langston Center for Innovation in Quality and Safety, Virginia Commonwealth University, Richmond (Dr Bleich).
Background:
The impact of aggressive and violent behaviors directed toward staff in psychiatric facilities has layers of implications tied to recruitment and retention, cost, quality and safety.
Local Problem:
Increased patient aggressive behaviors contributed to staff dissatisfaction and high turnover rates, triggering an analysis of current aggression management approaches.
Methods:
The Plan-Do-Study-Act quality improvement method was used for this project.
Interventions:
The Dynamic Appraisal of Situational Aggression (DASA) risk assessment tool was implemented.
Results:
Daily aggression risk identification increased by 69%, and aggressive incidents toward staff and patients decreased by 64% and 28%, respectively, when the tool was completed more consistently. Surveys revealed acceptance of the tool by nurses.
Conclusions:
Quality improvement statistical tools supported evidence-based strategies. A risk for aggression assessment laid the foundations for implementing strategies for reducing aggression and violence.
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