Increasing workplace violence in an Australian adult emergency department

Nikathil, Shradha; Olaussen, Alexander; Symons, Evan; Gocentas, Robert; O’Reilly, Gerard; Mitra, Biswadev

doi:10.1111/1742-6723.12872

Cited by 35 publications

(47 citation statements)

References 23 publications

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“…There was broad geographical variation in the primary studies: 13 were conducted in Australia, three were from the USA, three from the UK, and a study each from Canada, Cyprus, Italy, Jordan, Lebanon, Morocco, Nigeria, Palestine, Singapore, and Taiwan . Twenty‐seven (93%) studies scored 50–100% in the mixed methods appraisal tool indicating moderate to high quality.…”

Section: Resultsmentioning

confidence: 99%

“…Harmful physical contact can include (but not limited to) striking, slapping, punching, spitting, kicking, choking, biting, pushing, sexual assault and use of weapons against staff. Verbal abuse can include (but not limited to) yelling, insults, intimidation, threats, bullying, harassment, use of derogatory gestures and swearing …”

Section: Resultsmentioning

confidence: 99%

“…OV incidents varied between EDs, which ranged from 1.4 to 17 per 1000 presentations . At least 65% of ED staff experienced OV.…”

Section: Resultsmentioning

confidence: 99%

“…At least 65% of ED staff experienced OV. Specifically, 23–92% of staff experienced physical OV whereas 73–98% of staff experienced verbal form of OV …”

Section: Resultsmentioning

confidence: 99%

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Review article: Identifying occupational violence patient risk factors and risk assessment tools in the emergency department: A scoping review

Cabilan

Johnston

2019

Emerg Medicine Australasia

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Occupational violence (OV) is a daily risk for ED staff. It contributes to staff stress, sick leave, turn‐over and burn‐out, and limits the capacity of staff to provide unimpeded quality care to patients and their families. Many factors contribute to incidents of OV; however, early detection of such risk factors could pre‐empt incidences of OV during ED episodes of care. A five‐stage methodological framework for scoping reviews was used to identify, summarise and synthesise OV risk factors from five key databases. A validated tool was used to appraise the quality of included studies. Independent evaluation by the reviewers was used throughout. Patient factors were extracted and described from 24 methodologically and geographically diverse papers. Methodological quality for these studies varied from moderate to high. A total of 34 OV risk factors were identified. Although there was variation in, and differences between, staff‐perceived and objective (documented) OV risk factors, patient risk factors can be categorised into three main groups: clinical presentation, behaviours and past history. Five existing ED OV risk assessment tools were identified, with limited supporting evidence for each. The results support the development of a reliable and validated OV risk assessment tool to be initiated at triage.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Review article: Identifying occupational violence patient risk factors and risk assessment tools in the emergency department: A scoping review

Cabilan

Johnston

2019

Emerg Medicine Australasia

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“…Perpetrators of WPV in EDs may include patients or their families, other members of the public and other members of staff . Along with cognitive impairment, confusion, delirium, stress, frustration, grief, other substance misuse, mental health issues, and long waiting times, alcohol is an important risk factor for WPV during ED presentations . Alcohol was a factor in 12.6% of presentations to Australian EDs in a recent point‐prevalence survey and ED patients under the influence of alcohol were involved in almost 60% of WPV incidents in an Australian adult ED …”

Section: Introductionmentioning

confidence: 99%

Security interventions are frequently undocumented in emergency department clinical notes

Duncan

Brown

Hughes

et al. 2019

Emerg Medicine Australasia

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Objective To compare the documentation of security interventions in ED presentations between clinical notes and security records. Methods Presentations (n = 680) were randomly selected from all ED presentations to a public tertiary referral hospital in Queensland, Australia between April 2016 and August 2017 that were perceived by the treating clinician as alcohol‐related. Retrospective data, manually extracted from clinical notes and the security service database, were compared for the documentation of any security interventions. Security interventions were defined as observation without physical contact, verbal de‐escalation or physical restraint by security officers. Results Forty‐one presentations had security interventions documented in the security services database and, of those, 20 (48.8%) had documentation in the clinical notes. Patients who required security interventions were admitted to hospital in higher proportions compared with those who did not (73.2% vs 26.8%, respectively, P < 0.0001). Conclusion The rate of documentation of security interventions in clinical notes was less than 50%. Documentation of critical information, including alerts and risks, in the clinical notes is an essential component of communication that the multi‐disciplinary team use to ensure patient safety. Strategies aimed at improving the documentation of security interventions in clinical notes will help to optimise risk management and the safety of patients, staff and visitors along the continuum of care.

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Management of behavioural emergencies: a prospective observational study in Australian emergency departments

Yap

Taylor

Kong

et al. 2019

Pharmacy Practice and Res

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Background Behavioural emergencies (BEs) are complex situations in the emergency department (ED) setting. Treatment decisions always must be made within a limited time and are based on incomplete patient data. As a result of the urgency and complexity, patients often are exposed to increased risk of harm. Aim The aim of this paper is to describe the prescribing patterns and adverse events (AEs) associated with parenteral sedation for the management of BEs in Australian EDs. Methods Ten Australian EDs enrolled a convenience sample of adult patients (aged ≥18 years) requiring parenteral sedative medication for BEs. Data were collected prospectively between March 2015 and April 2017 using a designated case report form. Results In all, 564 cases were enrolled in this study. Incomplete cases (n = 17; 3%) were excluded. Of the 547 remaining cases, 63% were male and the median age was 34 years (range 18–95 years). Approximately half the patients (n = 230; 42.1%) required mechanical restraint and parenteral sedation to manage their BEs. Intramuscular monotherapy was administered in most cases (n = 390; 71.3%). The main sedative medications used as monotherapy were droperidol (n = 381; 69.7%), midazolam (n = 54; 9.9%) and olanzapine (n = 26; 4.8%). The most common combination therapy was midazolam + droperidol (n = 36; 6.6%). The incidence of AEs from sedative administration was 13.5%. No deaths or irreversible AEs were reported. Conclusions Overall, the participating EDs provided safe pharmacological management for BEs. AEs following parenteral sedation are common, although serious AEs are rare. Because all patients receiving parenteral sedation for BEs are at risk of AEs, ongoing monitoring of vital signs after parenteral sedation should be a standard protocol in all EDs.

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Increasing workplace violence in an Australian adult emergency department

Cited by 35 publications

References 23 publications

Review article: Identifying occupational violence patient risk factors and risk assessment tools in the emergency department: A scoping review

Review article: Identifying occupational violence patient risk factors and risk assessment tools in the emergency department: A scoping review

Security interventions are frequently undocumented in emergency department clinical notes

Management of behavioural emergencies: a prospective observational study in Australian emergency departments

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