Mock Codes Improve Multidisciplinary Behavioral Health Crisis Management in Inpatient Psychiatry

High levels of workplace violence occur in inpatient behavioral health settings, where verbal and physical aggression frequently test direct frontline staff, specifically nurses. Simultaneously, staff stress reactivity moderates the risk of assault, as does staff experience.

This pilot study examined whether a novel educational intervention concerning the implementation of mock behavioral crisis codes could improve staff skills, competence, and comfort in simulated workplace violence events and reduce the frequency of workplace violence episodes.

Behavioral mock codes were held monthly over 2 years, involving the entire multidisciplinary team on an urban inpatient psychiatric unit. An ad hoc rating scale applied by a multidisciplinary panel of experienced behavioral health clinical and security staff measured performance through team communication, proper patient escort, and prevention of patient and staff injury, while events of real-life workplace violence were monitored alongside qualitative data on staff knowledge, skills, and attitudes.

We observed an improvement in team performance measures as well as a reduction in reportable incidents of workplace violence over the intervention time period.

Our behavioral mock code intervention further demonstrated that consistent experiential learning enabled staff in this setting to safely and effectively manage crisis situations, while its success could suggest opportunities for application in other behavioral health systems.