QI Charter: A Risk Assessment Protocol To Improve The Management Of Aggression And Violence In A Psychiatric Setting

Author Biographical Info

Juliette Bateki is a registered nurse with a strong interest in psychiatric mental health. She is dedicated to advancing nursing practice through quality improvement initiatives and patient-centered care. Her professional focus is on enhancing safety and therapeutic outcomes in mental health settings. Outside of her clinical and academic work, she enjoys watching soccer, traveling, and exploring new cuisines through cooking. QI Charter: A Risk Assessment Protocol to Improve the Management of Aggression and Violence in a Psychiatric Setting is her first scholarly work in this area.

Date of Doctor of Nursing Practice Project Completion

Spring 5-6-2025

Faculty Advisor

Dr. Kearney Kelly

Abstract

Background: Patient care and staff safety are considered when determining aggressiveness and violence in psychiatric settings. However, structured violence risk assessment tools like the Broset Violence Checklist (BVC) are difficult to integrate into clinical practice when utilizing the prediction of violent behavior that allows healthcare professionals to intervene proactively. The BVC has been promising at predicting violence, but implementation needs to be done correctly, with proper training and integration into the routine workflow. Purpose: This project aims to implement the BVC as a violence and aggression predictive tool within a psychiatric intensive care unit. It aims to increase violence prediction among inpatients and decrease violence reports by 15%. Methodology: Using the Plan-Do-Study-Act quality improvement method, the BVC was tested in a psychiatric inpatient setting using a pre-post intervention design spanning 10 weeks. Pre- and post-violence data were used to confirm the BVC's effectiveness in reducing violence reports. The BVC's ability to predict violent patients among inpatients was assessed based on its rating. Results: Following BVC implementation, reports of violent incidents decreased by 19.4%, and staff injuries decreased by 100%. However, the BVC was more sensitive than specific, suggesting a high capability to identify at-risk patients and a high probability of over-predicting violence. Implication: The BVC is a valuable means of preventing violence in psychiatric settings and improving patient and staff safety. It depends highly on providing suitable training and integration. However, more research is needed to perfect its scoring system and ensure its long-term effectiveness in various clinical settings.

Keywords

Broset Violence Checklist, Violence management, Aggression, Sensitivity, Specificity

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