Using the Broset Violence Checklist to assess the risk of violence on Galaxy ward

Written by Racheal Kafero, Clinical Nurse Manager on Galaxy ward, and Matthew Oultram, Improvement Advisor

The Broset Violence checklist (BVC) is a structured risk assessment tool used by clinicians to assess the risk of violence. The BVC is part of the Safety Culture Bundle which was introduced at ELFT following a successful programme of work to reduce violence on inpatients wards between 2014-2019. The bundle is made up of 4 parts: the safety cross, safety huddle, community meetings and the BVC. We caught up with Racheal Kafero, Clinical Nurse Manager on Galaxy Ward, to speak about the BVC at Coburn.  

Tell us about the use of BVC on Galaxy ward…. 

Galaxy ward is an 11 bedded CAMHS Psychiatric Intensive Care Unit (PICU) within the Coburn centre at Newham. We provide care for those aged between 12 and 18 years old. Before the use of BVC, we found that our use of seclusion was increasing, and for some of our young people it was reocurring. Using the BVC to manage risk was one way in which we addressed this problem.   

What does the BVC consist of? 

The BVC has 8 different components, which the staff member works through to assess the young person. The components include – ‘is the patient confused, irritable boisterous, making verbal threats, physical threats, attacking objects, responding to de-escalation and are they compliant with PRN medication? Each component either scores a 0, for not presenting with, or a 1 for presenting with. The higher the score, the higher the risk of the behaviour of the service user. This assessment supports the staff member in deciding whether the young person continues seclusion, or to recommend other interventions to support the young person.  You can see a picture of the BVC template below:  

I would add that it is important to bear in mind that the checklist is a subjective assessment, and if you know the patient well, you can consider this in your assessment. For example, a patient can be really confused but easily redirected and reassured as their risk can be managed outside of seclusion with enhanced observations or a least restrictive approach. 

How does the BVC support with decision making on PICU?  

The decision making in CAMHS is different to adult services in that it is a very MDT focused approach due to the young person’s complex needs. The young people’s wider support network such as their families require involvement in order for the young person to flourish outside of being in hospital. There are psychologists, therapists, OTs who all do their own sessions with the service users. It is very much a group decision, rather than by individuals.  

The BVC helps to provide a rationale for either continuing seclusion or terminating it, which is a helpful guideline to nurses and can help them reflect on the reasons for seclusion. It can also give a good measure of any improvements for the young person in seclusion, for example, where their BVC score was 8 previously and is now 5.  

Is the BVC used alongside any other elements of the Safety Culture Bundle? 

We have our safety huddles, where we discuss the young people and raise any causes for concern. We use this space to look at their BVC scores and think about what we can do to support them.