A Quality Improvement Approach to Violence Reduction: Standardizing the Risk Identification Process

Area of Science:

• Psychiatric Nursing
• Healthcare Quality Improvement
• Patient Safety

Background:

• Aggressive and violent behaviors in psychiatric facilities negatively impact staff recruitment, retention, costs, and safety.
• High patient aggression rates correlate with staff dissatisfaction and turnover, necessitating improved management strategies.

Purpose of the Study:

• To analyze current aggression management approaches in psychiatric settings.
• To evaluate the effectiveness of the Dynamic Appraisal of Situational Aggression (DASA) tool in reducing patient aggression.

Main Methods:

• The Plan-Do-Study-Act (PDSA) quality improvement methodology was employed.
• The Dynamic Appraisal of Situational Aggression (DASA) risk assessment tool was implemented to identify and manage patient aggression.

Main Results:

• Consistent use of the DASA tool led to a 69% increase in daily aggression risk identification.
• Aggressive incidents toward staff decreased by 64%, and patient-on-patient aggression decreased by 28%.
• Nurses reported positive acceptance and utility of the DASA tool.

Conclusions:

• Quality improvement tools, like DASA, support evidence-based strategies for managing aggression.
• Implementing a systematic risk assessment tool is foundational for reducing aggression and violence in psychiatric care.