Introduction of the Brøset Violence Checklist on a PICU

Abstract

Background and aims: This survey pragmatically appraised the utility of the Brøset Violence Checklist (BVC) and its potential usefulness in guiding proactive management and interventions to help reduce episodes of violence and/or aggression within a psychiatric intensive care unit (PICU). Emphasis was placed on evaluating whether this instrument was completed prior to an episode of violence and/or aggression, and (through development of an appropriate action plan) the relationship it had on management plans.<br/> Method: Use of the BVC was introduced on a PICU. Incidents of disturbed patient behaviour were collated over a 13 week period using the DATIX incident reporting system. BVC records completed over the 24-hour period prior to any incident were examined. Usage of risk management plans developed after BVC completion was identified. Plans were coded as 'Use of medication', 'Environmental interventions' or 'Restrictive practice'. <br/> Results: 86 incidences were reported. Results suggested satisfactory completion of BVC score sheets for all patients. Management plans were noted as being present and robust for patients whose BVC scores were higher (≥3), as recommended by the tool. It was noted that implementation of restrictive interventions was less than use of either medication or environmental contingencies within proposed risk management plans. However, following an episode, management plans were not reviewed.<br/> Conclusion: An empirically-validated measure to predict potential risk of violence within a PICU was introduced and appropriate management strategy plans developed. Incorporating use of a structured short term risk assessment tool was therefore deemed to be a useful addition to standard procedures.