Reducing Patient Aggression Through a Nonviolent Patient De-escalation Program: A Descriptive Quality Improvement Process.

BACKGROUND

Patients commonly display aggressive and violent behaviors toward nursing staff, contributing to severe consequences. Healthcare institutions must develop and implement systems addressing this global safety problem.

AIM

To improve clinical practice safety for inpatient acute care settings by providing healthcare teams throughout a large academic medical center with a Behavioral Emergency Response Team (BERT) program, that is, a system for reporting and de-escalating aggressive patient encounters.

METHODS

This descriptive quality improvement process took place within two inpatient acute care departments using simulation-based training, patient safety rounds, and a BERT activation system. Participant groups included nursing personnel who completed a baseline survey (n = 302), telecommunication dispatchers (n = 20), BERT responders (n = 78), and bedside nursing staff (n = 43) recipients of BERT program resources. Methods included a baseline questionnaire, pre- and post-intervention surveys, formal reports of aggressive patient encounters, documentation from patient safety rounds, and records of activated BERT responses. Data analysis included descriptive statistics, boxplots, and the Wilcoxon signed-rank test.

RESULTS

This project mitigated patient aggression episodes by successfully designing and implementing an evidence-based BERT program. Findings suggested bedside nursing program participants felt more confident and capable of managing aggressive patient behaviors. A strong partnership between security officers and nursing staff limited the risk of harm to clinical staff by identifying and intervening with 41 potentially aggressive patients. Finally, formal reports of patient aggression episodes did not increase during this project, which may have indicated early prevention and detection of aggression while reflecting the broader problem of aggression under-reporting in nursing.

LINKING EVIDENCE TO ACTION

Healthcare organizations need to have robust systems to manage aggressive patient encounters. Comprehensive strategies for managing patient aggression include simulation-based training, the use of BERT responders, and a strong partnership between nursing and security officer teams.