Good evidence-based assessment for assault precautions?

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Greetings,

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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Specializes in Psych, Addictions, SOL (Student of Life).

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.

Hppy

1
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Specializes in Psychiatry.
On 1/28/2019 at 6:20 PM, hppygr8ful said:

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.

Hppy

Hppy,

What setting do you work in? You seem to be fairly knowledgeable on this issue. I’d like to address my manager to set up an aggression risk assessment scale where I work — a 10-bed medical psychiatric unit at a rural hospital in central Washington. Would you be able to give me a few pointers with this?

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Specializes in Psych, Addictions, SOL (Student of Life).
2 hours ago, stacyayako said:

Hppy,

What setting do you work in? You seem to be fairly knowledgeable on this issue. I’d like to address my manager to set up an aggression risk assessment scale where I work — a 10-bed medical psychiatric unit at a rural hospital in central Washington. Would you be able to give me a few pointers with this?

I work in an acute crises stabilization hospital. Currently I work with adolescents but have worked with all populations over the past 20 years. The psych nurses primary job is unit/patient/staff safety. Would be happy to discuss our safety measures with you.

Hppy

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Specializes in Psychiatry.
On 5/1/2019 at 5:41 PM, hppygr8ful said:

I work in an acute crises stabilization hospital. Currently I work with adolescents but have worked with all populations over the past 20 years. The psych nurses primary job is unit/patient/staff safety. Would be happy to discuss our safety measures with you.

Hppy

What violence risk assessments have you worked with? Would you be able to tell me pros and cons of them? I am particularly interested in the DASA-IV and thinking of presenting it to my boss for use in our facility. Any information would be greatly appreciated!

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Specializes in Psych, Addictions, SOL (Student of Life).
47 minutes ago, stacyayako said:

What violence risk assessments have you worked with? Would you be able to tell me pros and cons of them? I am particularly interested in the DASA-IV and thinking of presenting it to my boss for use in our facility. Any information would be greatly appreciated!

My facility likes to reinvent the wheel so we sort of have our own assessment and it scores from zero risk (nobody) all the way up to very high risk. Still the DASA is a pretty good tool. I have to say that I sometimes rely on my Spider Man senses more than any man made scale. Still it's nice to have a tool.

Hppy

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Specializes in Psychiatry.
4 minutes ago, hppygr8ful said:

My facility likes to reinvent the wheel so we sort of have our own assessment and it scores from zero risk (nobody) all the way up to very high risk. Still the DASA is a pretty good tool. I have to say that I sometimes rely on my Spider Man senses more than any man made scale. Still it's nice to have a tool.

Hppy

Thanks for your response!!

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