(167) The Brøset Checklist: A Pilot Study for Patients at Increased Risk for Violence – Identification and Intervention

‎Background/Significance: Violence against healthcare workers is on the rise (Watson et al, 2020). Workplace ‎violence (WPV) is a primary focus of current regulatory agencies such as the Joint Commission. Exposure to WPV can ‎negatively impact ability to provide effective patient care contributing to psychological distress, job dissatisfaction and ‎early burnout, high turnover, lower retention rate, and increased costs (TJC, 2021). The Broset violence checklist (BVC) ‎is an evidence-based risk assessment tool used to predict inpatient violence (Anderson et al, 2019).‎

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Methods: In November 2021, Lahey Hospital and Medical Center (LHMC) formed a multidisciplinary ‎Workplace Violence Prevention Committee (WVPC) "for the development and implementation of the practices, ‎policies, training and supports needed to maintain a safe, non-threatening environment for all colleagues, patients, ‎visitors and others." With the support of IT and nursing leadership, the BVC was incorporated into the electronic ‎medical record (Epic) and educational material was created. Beginning in May 2023, the WVPC will roll out a three-‎month pilot study on two selected units (one intensive care unit and one combined "progressive care" and general ‎medicine/surgical unit). Patients that screen positive will generate a "Best Practice Advisory" to consider psychiatric ‎consultation. Positive screens will also generate immediate notification to security for support and proactive rounding, ‎as well as use of a buddy system when providing care. We intend to evaluate the following datapoints in the three ‎months before and after implementation: restraint use, events needing security assistance, physical assaults, and ‎safety/sitter FTE data. In addition, we intend to look at the percentage of positive screens, which of those patients ‎generated psychiatric consultations and the effects of psychiatric consultation on administration of antipsychotic ‎medication and length of stay. Lastly, we intend to roll out a before/after nursing survey on perceived competence ‎towards managing violence.‎

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Results: We hypothesize that this data, which we anticipate having prior to the November ACLP meeting, will ‎further shed light on the effects of screening for violence on quantifiable patient/staff harm outcomes, as well as the ‎effects of "proactive psychiatric consultation" for those deemed at high risk of self-harm.‎

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Discussion: Violence in the inpatient setting is increasingly becoming a focus of hospitals across the country ‎and psychiatry consultation services are often relied upon to help manage difficult interpersonal situations involving ‎risk of harm. We seek to answer the question of how a quantifiable screener such as the BVC might be utilized to ‎identify patients at elevated risk of violence as well as practically guide next steps.‎

‎Conclusion/Implications: We believe that such a study will have practical guidance for the CL psychiatrist ‎engaged in interdisciplinary hospital-led efforts to reduce hospital violence.‎

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References: ‎
‎1. Watson, A., Jafari, M., & Seifi, A. The persistent pandemic of violence against health care workers. Am J Manag Care. ‎‎2020 Dec 1;26(12):e377-e379.‎
‎2. The Joint Commission. Workplace violence prevention standards - joint commission. 2021. Retrieved March 31, 2023, ‎from https://www.jointcommission.org/-/media/tjc/documents/standards/r3-reports/wpvp-r3_20210618.pdf.‎
‎3. Anderson, K. K., & Jenson, C. E. Violence risk–assessment screening tools for acute care mental health settings: ‎Literature review. Arch Psychiatr Nurs. 2019 Feb;33(1):112-119.‎