ASSAULT PREVENTION THROUGH USE OF RISK FOR VIOLENCE SCREENING TOOL

Introduction: Healthcare workers in hospital-based Emergency Departments (EDs) experience high rates of workplace violence perpetrated by patients. Aim: The purpose of this quality improvement project was to implement and evaluate the effectiveness of a risk for violence screening tool (RVST) in an urban, academic trauma center ED to reduce staff assaults through an alert system and focused assault prevention strategies. Method: Using the socioecological framework, facility, and literature-based risk factors for assaultive behavior, a RSVT to flag patients for aggression reduction strategies was developed, implemented and evaluated. Six steps included the following: (1) adult patients screened at triage for risk criteria for violence, (2) positive risk patients identified with a Golden Hand (GH), (3) Electronic Medical Record (EMR) tracking system flagged with GH symbol to alert staff to risk, (4) GH signage posted to communicate patients’ violence propensity, (5) assault prevention strategies implemented, (6) permanent EMR flag for repeatedly assaultive patients. Results: Physical assaults on staff were recorded and tracked monthly from January 2019, through January 2021, through a retrospective review of the hospital’s online incident report system. Patient-to-staff physical assaults decreased from a range of one to four per month to a range of zero to one per month. Triage screening accuracy and compliance for patients who were assaultive increased from 33% compliance and 0% accuracy, to 96% compliance and 83% accuracy. Conclusion: Risk for violence screening upon arrival, an alert system, and assault mitigation strategies provide an opportunity for nurse leaders to promote ED workplace safety. Keywords: workplace violence, healthcare worker assault, violence, aggression, emergency department, prevention, risk for violence screening tools, framework