Reducing Violence on Acute Wards

As the Trust’s quality improvement programme starts to take shape (with the strategy agreed by the Trust Board, the project structure coming into place, and our procurement of a strategic partner due to complete in February), we’d like to share with you the quality improvement journey of one of our teams that has been testing this approach for the past year as part of a pilot. In this article, Paul McLaughlin, Modern matron on Globe Ward at the Tower Hamlets Centre for Mental Health tells us what they have been doing to improve quality.

Reducing the level of violence and aggression on acute wards is clearly something that is important to patients and staff. Over a year and a half ago Globe Ward piloted the use of the Broset Violence Checklist (BVC) in Tower Hamlets as part of a project to move towards being a ‘zero violence’ ward.

The BVC itself is very easy to use. It is a simple 6-item scale that is designed to help staff quickly identify behavioural cues associated with an increased risk of violence – the idea being that a high score should then prompt staff to offer some kind of team intervention, from de-escalation and talking, through to use of PRN medication, referral to PICU, and so on.

The evidence from Globe Ward is that the BVC can help to reduce violence. The number of Datix incidents recorded under ‘violence and aggression’ has reduced by well over 50%, and for over a year there has not been a violent incident on the ward where anyone – patient or staff – has been hurt.

Paul McLaughlin, Matron for the ward:

Clearly the BVC is not the only answer, it’s just a risk assessment tool. What I like about it, however, is that it is nurse-led. It empowers registered and unregistered nursing staff to be proactive and take the lead on reducing violence. If a patient is becoming aggressive, there is no point in waiting until the ward round to mention it to the consultant. Staff should do something about it then and there.

The BVC pilot came at a good time for Globe Ward. Dr Feddi Jonsson, our wonderful lead consultant, and all the consultants on the ward, gave the pilot their full support.

We have developed a great multi-disciplinary team here with a relatively flattened hierarchy. There is a relaxed atmosphere and ease of communication. What part the BVC itself has played in this teamwork is hard to say. I am certain though that the BVC has helped junior nursing staff to see reducing violence as very much a shared endeavour, with their role as central and key. We have some extremely talented and qualified social therapists and recovery workers. The BVC helps to create a team where those talents are fully employed, to the benefit of everyone.

Reducing violence on Globe ward