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oceanblue52 oceanblue52 (Member)

Good evidence-based assessment for assault precautions?

Psychiatric   (238 Views 2 Comments)
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Outpatient Psych RN here. Had an adverse incident recently where we were giving a client an injection and said client grabbed scissors off the desk and injured himself. 911 was called and client was stabilized. Our outpatient facility is now reviewing protocols to prevent this incident from happening again. 

Of course the obvious first suggestion is to not leave items that can be used like weapons around in easy reach...in this case it was a human error and of course our staff plans to be more careful with keeping these sorts of items out of reach. Rest assured our staff member feels terrible about leaving a sharp object out and nursing staff is now hyper vigilant about reviewing our environments before client encounters. Honestly though even if obvious sharp objects were tucked away, there were other items the client could have grabbed. 

Other than controlling the environment better, does anyone working in outpatient use an evidence-based assessment for predicting who might act out/commit assault so better precautions can be put in place? In an outpatient setting it is tricky dealing with patients who are easily agitated because we don’t have security backup in place. Am thinking a risk assessment is a good start to tackling this issue? 

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When it comes to risk for self harm which is what happened in your case and risk for harm to others - I don't trust any patient any farther than I can throw them. We do have a couple of standardized risk assessments we use but patients can score low and kill themselves or hurt others. 

some scales I have seen are:

Broset Violence Checklist (BVC), 

Dynamic Appraisal of Situational Aggression (DASA)

Modified Overt Aggression Scale (MOAS).

one thing we do is keep all sharps in a locked drawer and the contents are signed out when needed and signed back in.

There are a number of scholarly articles on this topic which you can access through google scholar or any on-line college library if you have access to one. 

Let me know if you need further help in finding these articles. 


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