Aggression in Psychiatric Wards: Effect of the Use of a Structured Risk Assessment

Abstract

Health care workers are often exposed to violence and aggression in psychiatric settings. Short-term risk assessments, such as the Brøset Violence Checklist (BVC), are strong predictors of such aggression and may enable staff to take preventive measures against aggression. This study evaluated whether the routine use of the BVC could reduce the frequency of patient aggression. We conducted a study with a semi-random regression discontinuity design in 15 psychiatric wards. Baseline aggression risk was assessed using the Aggression Observation Short Form (AOS) over three months. The BVC was implemented in seven intervention wards, and the risk of aggressive incidents over three months of follow-up was compared with the risk in eight control wards. The analysis was conducted at the ward level because each ward was allocated to the intervention and control groups. At baseline, the risk of aggression varied between wards, from one aggressive incident per patient per 1,000 shifts to 147 aggressive incidents per patient per 1,000 shifts. The regression discontinuity analysis found a 45% reduction in the risk of aggression (Odds Ratio (OR) = 0.55, 95% confidence interval: 0.21-1.43). The study did not find a significant reduction in the risk of aggression after implementing a systematic short-term risk assessment with the BVC. Although our findings suggest that use of the BVC may reduce the risk of aggression, the results need to be confirmed in studies with more statistical power.

Assessing the risk of violence in a psychiatric clinic: the Brøset Violence Checklist (BVC) Turkish version—validity and reliability study

“…If an increase in confusion was observed, a score of “1” was given. Interpretation of the scores: “0” indicates that the risk of violence is low; “1” and “2” indicate that the risk is moderate and that preventive measures should be taken; scores above “2” indicate that there is a high risk of violence within the next 24 hours, in which preventive measures should be taken and that countermeasure plans should be developed against a possible attack …”

“…Aggression in psychiatric inpatients is a substantial problem for the patients, their families, and employees . It has been maintained that the level of violence in psychiatric inpatient units is twice as high as in other fields of medicine .…”

“…It has been maintained that the level of violence in psychiatric inpatient units is twice as high as in other fields of medicine . Hence, there has been an increase in recent years in the number of studies carried out for determining the causes, effects, prevalence, severity, and management of violence from inpatients in psychiatric clinics In a study of nurses working in a large mental health center in Israel, based on their statements, it was found that of them, 88.1% and 58.4% were exposed to verbal violence and physical violence respectively perpetrated by patients in the past year . In a study on the prevalence of and reasons for aggression in inpatients conducted in Nigeria, Chukwujekwu, and Stanley found that the prevalence of aggression was 19.5%, of which aggression without provocation accounted for 63.3%.…”

“…This checklist is regarded as a tool that can predict violent behavior, it is fast and easy to use, and it can readily be integrated with day‐to‐day clinical applications to supplement clinical evaluations . The BVC is widely used in a variety of settings worldwide, for example, Norway, Sweden, Switzerland, Canada, Denmark, Portuguese, and China …”

A tool to evaluate proportionality and necessity in the use of restrictive practices in forensic mental health settings: The DRILL tool (Dundrum Restriction, Intrusion and Liberty Ladders).

“…While there is some evidence that use of restrictive and coercive practices are not reducing (10,21,22), there is evidence that the systematic introduction of structured risk assessment can reduce levels of violence and aggression in psychiatric wards (23,24) and that the use of short term risk assessment to reduce violence does so by leading to appropriate interventions (25) and evidence that short term risk assessment reduces coercive practices (26) and aggression (27,28) along with other preventive measures (8,29). The criticism that there is lack of evidence for the effectiveness of preventive practices may arise from lack of a theoretical framework, lack of a validated system for description and lack of a system for measurement so that scienti c studies have not been possible.…”