Abstract
This study examined the ability of a risk assessment algorithm, the Risk of Harm to Others Clinical Assessment Protocol (RHO CAP) to predict inpatient aggression within a mental health and addictions treatment facility in Ontario, Canada. Anonymized patient records were retrospectively reviewed from April 1, 2004 to July 31, 2009 (N = 6,425). Survival analysis using Cox’s regression was used to predict time to inpatient aggression using the RHO CAP. Approximately 10% of inpatients were at moderate risk of harm to others, and 2% were considered high risk. The pattern of survival curves revealed that within the first month of admission, approximately 10% of inpatients at high risk of harm to others displayed physical aggression. Patients at high risk were also two times more likely to display physical aggression. Clinical teams can use the RHO CAP to implement preventive safety measures, reduce the incidence of inpatient aggression and improve quality of care.
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Day HD, Franklin JM, Marshall DD. Predictors of aggression in hospitalized adolescents. Journal of Psychology, 1998; 132: 427-434.
Morrison EF. The culture of caregiving and aggression in psychiatric settings. Archives of Psychiatric Nursing, 1998; 12: 21-31.
Serper MR, Goldberg BR, Herman KG, et al. Predictors of aggression on the psychiatric inpatient service. Comprehensive Psychiatry, 2005; 46: 121-127.
Owen C, Tarantello C, Jones M, et al. Repetitively violent patients in psychiatric units. Psychiatric Services, 1998a; 49: 1458-1461.
Linaker OM, Busch-Iversen H. Predictors of imminent violence in psychiatric inpatients. Acta Psychiatrica Scandinavica, 1995; 92: 250-254
Dinakar HS, Sobel RN. Violence in the community as a predictor of violence in the hospital. Psychiatric Services, 2001; 52: 2-3.
Grube M. Gender differences in aggressive behavior at admission to a psychiatric hospital. Aggressive Behavior, 2007; 33: 97-103.
Owen C, Tarantello C, Jones M, et al. Violence and aggression in psychiatric units. Psychiatric Services, 1998b; 49: 1452-1457.
Bjorkly S. Predictors of aggression in psychiatric patients: a review of prospective prediction studies. Clinical Psychology Review, 1995; 15: 475-502.
Soliman AE, Reza H. Risk factors and correlates of violence among acutely ill adult psychiatric inpatients. Psychiatric Services, 2001; 52: 75-80.
World Health Organization [WHO]. World Report on Violence and health: Summary. Geneva, WHO; 2002
Soreff S, Siddle D. Understanding and dealing with resident aggression: exploring the extent, causes, and impact of aggressive outbursts and how to handle them. Nursing Homes, 2004. Available at: http://findarticles.com/p/articles/mi_m3830/is_3_53/ai_n6066074/ Accessed November 20, 2009.
Hirdes JP, Curtin-Telegdi N, Mathias K, et al. interRAI Mental Health Clinical Assessment Protocols (CAPs) for Use with Community and Hospital-Based Mental Health Assessment Instruments. Version 9.1. Washington, DC: interRAI; 2011
Hirdes JP, Marhaba M, Smith TF, et al. Development of the resident assessment instrument mental health (RAI-MH). Hospital Quarterly, 2001; 4: 44-51.
Ministry of Health and Long-term Care. Implementation of Ontario mental health reporting system. 2004. Available at: http://www.mohltcfim.com/cms/upload/a_7137/mohrs_memo.pdf. Accessed August 12, 2009.
Martin L, Hirdes JP, Morris JN, et al. Validating the Mental Health Assessment Protocols (MHAPs) in the Resident Assessment Instrument Mental Health (RAI-MH). Journal of Psychiatric and Mental Health Nursing, 2009; 16: 646-653.
Hirdes JP, Prendergast P, Smith TF, et al. The Resident Assessment Instrument—Mental Health (RAI-MH): inter-rater reliability and convergent validity. Journal of Behavioral Health Services and Research, 2002; 29:419-432.
Hirdes JP, Ljunggren G, Morris J, et al. Reliability of the interRAI suite of assessment instruments: a 12-country study of an integrated health information system. BMC Health Services Research, 2008; 8: 277.
Burrows AB, Morris JN, Simon SE, et al. Development of a Minimum Data Set-based depression rating scale for use in nursing homes. Age and Ageing, 2000; 29: 165-172.
Morris JN, Fries BE, Mehr DR, et al. MDS Cognitive Performance Scale. Journals of Gerontology, 1994; 49: M174-M182.
Morris JN, Fries BE, Morris SA. Scaling ADLs within the MDS. The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences, 1999; 54: M546-553
Perlman CM, Hirdes JP. The Aggressive Behaviour Scale: A new scale to measure aggression based on the Minimum Data Set. Journal of the American Geriatrics Society, 2008; 56: 2298-2303.
Fries BE, Simon SE, Morris JN, et al. Pain in U.S. nursing homes: validating a pain scale for the Minimum Data Set. The Gerontologist, 2001; 41: 173-179.
Perlman C, Barbaree H, Brown G, et al. Harm to others clinical assessment protocol. In Hirdes JP, Curtin-Telegdi N, Mathias K, et al. interRAI Mental Health Clinical Assessment Protocols (CAPs) for Use with Community and Hospital-Based Mental Health Assessment Instruments. Version 9.1. Washington, DC: interRAI; 2011
Allison P. Survival Analysis Using the SAS System: A Practical Guide. Cary, NC: SAS Institute Inc, 1995.
Rocca P, Villari V, Bogetto F. Managing the aggressive and violent patient in the psychiatric emergency. Progress in Neuro-Psychopharmacology & Biological Psychiatry, 2006; 30: 586-598.
Harris, M. B. Aggressive experiences and aggressiveness: relationships to ethnicity, gender and age. Journal of Applied Social Psychology, 1996; 26: 843-870.
Vinkers, D. J., De Vries, S. C., Van Baars, A. W. B., & Mulder, C. L. Ethnicity and dangerousness criteria for court ordered admission to a psychiatric hospital. Social Psychiatry and Psychiatric Epidemiology, 2010; 45: 221-224.
El-Badri, S. M. & Mellsop, G. Aggressive behavior in an acute general adult psychiatric unit. Psychiatric Bulletin, 2006; 30: 166-168.
Davis S. Violence by psychiatric inpatients: a review. Hospital and Community Psychiatry, 1991; 42: 585-590.
Nicholls TL, Brink J, Greaves C, et al. Forensic psychiatric inpatients and aggression: an exploration of incidence, prevalence, severity, and interventions by gender. International Journal of Law and Psychiatry, 2009; 32: 23-30.
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The authors gratefully acknowledge the helpful comments on a preliminary draft of this manuscript from AC and CW.
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Results from this manuscript were presented at the annual meeting of the International Network for Excellence in Mental Health (iNEMH), in Reykjavik, Iceland: October 12–18, 2009.
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Neufeld, E., Perlman, C.M. & Hirdes, J.P. Predicting Inpatient Aggression Using the InterRAI Risk of Harm to Others Clinical Assessment Protocol. J Behav Health Serv Res 39, 472–480 (2012). https://doi.org/10.1007/s11414-011-9271-x
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DOI: https://doi.org/10.1007/s11414-011-9271-x