The purpose of this presentation is to discuss efforts to reduce violence and seclusion rates on a psychiatric emergency services unit. Through the implementation of an evidence-based protocol that includes assessment of violence risk using a validated tool, identifying de-escalation and coping techniques, and post-incident debriefs rates of violence and seclusion declined. The session will include a brief background, a description of the setting and population, interventions used, pre- and post-intervention data, lessons learned, limitations, future recommendations, and implications for practice.
Tool: Violence Assessment Tool (VAT) ; Seclusion Debriefing Tool
Problem: The April to September 2023 rate of seclusion hours for the psych emergency department (ED), 5.57/1,000 patient care hours the national average, 0.35/1,000 patient care hours. The site has a policy for seclusion when imminent risk of harm presents but there is no standardized preventative screening process for all patients.
Tool Selection: The American Psychiatric Nurses Association emphasizes prevention and reduction of seclusion and use of evidence-based tools to predict aggression and prevent escalation. Evidence supports a multi-component intervention to reduce seclusion rates, including debriefing and assessment tools, leadership engagement, and protocols incorporating safety initiative programs such as Six Core Strategies.
Usage: Nurses administer the VAT for all patients seen in psychiatric ED; stratified interventions based on the VAT risk level and identification of patient specific agitation and de-escalation preferences communicated to the inpatient units. Seclusion debriefing form completed post-incident with staff identifying antecedents, trending behaviors, and opportunities for improvement.
Results: Workplace Violence reports decreased 45.83% across the psych ED and inpatient psych units. There was a 5% reduction in seclusion rates across the adult inpatient psychiatry units. PDCA utilized in the implementation process with reinforcement and discussion through monthly shared governance and staff meetings.
