Reducing Coercive Measures to Improve Patient and Staff Safety by Increasing the Frequency of Risk Assessment

Violence is a critical issue in Healthcare. Inpatient psychiatric nurses are the healthcare professionals most affected by this problem. Structured risk assessment tools can predict imminent aggression, prompt interventions, mitigate the advent of aggressive behaviors and staff and patient injuries, and reduce restrictive aggression management methods. This quasi-mixed methods project instructed registered nurses in an acute inpatient psychiatric unit to implement the Dynamic Appraisal of Situational Aggression (DASA: IV) more frequently to determine the impact on aggressive behaviors, the use of coercive techniques to manage aggression, and to assess nurses\u27 perception of the tool. Twenty-five registered nurses screened 447 patients over 28 days using the DASA: IV tool. Pre-implementation and implementation data were collected and analyzed with the statistical methods of percentage change, 2-tailed t-test, and ANOV A. The results indicated a 58.55% reduction in overall assault rates and a 20% reduction in the use of seclusions and restraints (S&R). A majority of participants had positive attitudes toward implementing the tool. Implementation of a DASA: IV protocol is feasible and may improve safety in adult inpatient acute psychiatric units