Arnetz et al
7
| USA, 7 hospitals, 41 units, 2800 employees | Level 2 Moderate | RCT intervention 5 years, 4 phases Data-driven, worksite-based intervention Plan-Do-Check-Act Hazard risk matrix to identify high-risk units in intervention and control groups |
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Rates of violent events Rates of violence-related injuries Intervention group compared with control group Evolution over time compared with baseline
| Rates of violent events:Six months postintervention, incident rate ratio (IRR) of violent events was significantly lower on intervention units compared with control IRR 0.48 (95% CI 0.29 to 0.80) Rates of violence decreased slightly but not significantly in the intervention group compared with baseline and increased significantly in the control group compared with baseline. Significantly increased violent event rates at 24 months compared with baseline in both groups: intervention group from 8 to 13.8 per 100 FTE and control group from 8 to 15.4 per 100 FTE.
Violence-related injuries:
Remark: results were not consistent over time during the 24-month follow-up period. |
Abderhalden et al
28
| 14 acute psychiatric wards, 2364 patients, Switzerland, PSY | Level 2 Moderate | RCT: 14 acute psychiatric wards, 2364 patients phase 1: 3 months baseline data phase 2: 3 months intervention period |
Structured short-term risk assessment : Swiss version of the BrØset Violence Checklist, 2 times per day during the first 3 days In case of high risk (1 in 10 patients will physically attack during next shift): discuss possible prevention measures from the list In case of very high risk (1 in 4 patients): multidisciplinary team discussion on preventive measures and plan and implement preventive measures
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Significant reduction in severe events of patient aggression: adjusted risk reduction 41% intervention vs control 15%, p<0.001. Significant reduction in attacks: 41% vs 7%, p<0.001. Significant reduced need for coercive measures : 27% reduction in intervention group vs 10% increase in control, p<0.001. Admitted psychiatric patients combined with a communication of risk scores and a recommendation for action tailored to risk level reduced the incidence rate of coercive measures and severe aggressive incidents.
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JE Arnetz and BB Arnetz42
| 47 healthcare workplaces 1500 nurses in EDs, geriatric, psychiatric, home healthcare, Sweden, ED, Psy, GER | Level 3 Low | RCT Implementation and evaluation of a practical intervention programme for dealing with violence towards healthcare workers |
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Awareness of risks of violence Ability to deal with aggressive situations Exposure to violent incidents
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Lipscomb et al
14
| Mental health facilities, New York state, 26 units: 6 units selected, Psy | Level 3 Low |
Evaluation of the impact of OSHA guidelines on workers’ health and safety Three intervention groups, three comparison groups Baseline and postintervention survey 4 years study
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Management commitment to the violence prevention programme Employee involvement in VPP Hazard assessment activities Hazard control activities: infrastructural, organisational, environmental, administrative, behavioural Training
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Staff in both intervention and comparison groups reported significant improvements in the first four elements of the OSHA elements (low). Intervention facilities reported significant improvement in the training element (low). No significant reduction in the change in physical assaults in the intervention group nor in the comparison group. Significant increase in threats of assault in the intervention group (+98%, p<0.001), a non-significant increase in the comparison group (+47%, p=0.08). Remark: both the intervention and the comparison groups did implement safety preventions but the comparison groups did not benefit from the support of the team resources of the worksite violence study.
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Magnavita36
| Small-scale psychiatric unit, Italy, about 85 workers | Level 3 Low |
| Aggression minimisation programme as part of total quality managementArchitecture and work organisation:
Rearrangement of building three assistance areas depending on severity of mental illness Increased nurse-to patient ratios, staff coverage Remove patients from monitoring tasks Improved lighting Safety alarms Education
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Violence incident form Assault rate: preintervention and postintervention Assault rate for aggression using physical force Verbal abuse, and so on, not addressed
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Kling | Acute care hospital, Canada, 109 cases | Level 3, Low | Preintervention and postintervention study evaluation of the violent risk assessment system and retrospective case control | Violence risk assessment flagging in patient file and on wrist band and violence prevention training taking precautions such as: wearing personal alarm, security team nearby, not entering patient room alone, not having sharp objects |
| During intervention compared with preinterventionRR hospital: 0.57 (0.33–1.83) (not significant). RR direct patient care workers: 0.52 during intervention (0.33 to 0.81). RR high-risk department: 0.39 (0.24 to 0.61). Postintervention compared with preintervention. RR hospital 1.01 (0.989 to 1.04). RR direct patient care workers 1.03 (1.00 to 1.06). RR high risk department: 1.04 (1.01 to 1.07). In contrast to hypothesis: Adjusted OR for violent incident 6.28 for patients flagged by the alert system.
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Mohr et al, 15
| 138 veterans healthcare facilities | Level 3 Low |
Longitudinal study Impact of implementation of a workplace prevention programme on rates of workplace violence over a period of 6 years: 2004–2009 Relationship of assault rates with workplace violence dimension score Percentage change in assault rates in 2009 compared with 2004
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43 workplace violence prevention items, grouped into three dimensions : training, workplace practices, environmental control and security Standardised assault rate
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Overall there was an increase in assault rates over time: from 59 to 71 per 10.000 FTE. 34% of facilities had reduced assault rates, average improvement 42%. Facilities with no reduction had an average increase of 125% in assault rate. Training dimension: significant but moderate 5% reduction on standardised incidence rate (low). No significant change in assault rates over time. Possible explanation: Large differences in facilities in assault rate reduction or increase. Under-reporting prior to the workplace violence prevention programme. Reduction in severity of assaults (workers compensation claims declined 40% between 2001 and 2008).
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Hvidhjelm et al
44
| Forensic psychiatry, 156 patients, Denmark, Psy | Level 3 Low |
Population-based observational study Sensitivity and specificity of the BrØset Violence Checklist 156 patients, checked three times per day during 24 months
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BVC six items checklist as predictor of short-term (<24 u) risk of violence Score six items: presence or absence of: confusion, irritability, boisterousness, physical threat, verbal threat, attack on objects
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| BVC showed overall satisfactory specificity and sensitivity as a predictor of short-term risk of violence, (low) score ≥3:
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Partridge and Affleck45
| ED, 2046 patients, Australia | Level 3 Low |
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| BVC showed a good sensitivity, specificity and predictive value of short-term risk of violence, (low): overall risk 1.7%Score ≥1: PPV 16.7%, LR +11.6, sensitivity 88.6%, specificity 92.4%. Score ≥2 : PPV 34.2%, LR +30.3, sensitivity 65.7%, specificity 97.8%. Score ≥3: PPV 55.2%,LR +71.4 sensitivity 45.7%, specificity 99.4%.
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Morken and Johansen
24
| 210 emergency primary care centres, Norway, GP | Level 5 Very low | Cross-sectional study, survey on application of 22 safety measures items in 210 emergency primary care centres |
Available staff: extra person during home visit when needed (44%), more then one person on duty (30%). Reception design with glass barrier (86%), view to entrance (62%) and waiting rooms (72%). Consulting room set-up: alternative exit (59%), quick entrance/exit for staff (46%), patient not sitting between clinician and door (29%). Electronic safety systems: alarm on medical radio network (74%), automatic door lock (54%), portable alarm (28%), CCTV camera (28%), and so on. Training (40%). Reporting: monitor and follow-up of violence episodes (75%). No reporting of number of violent incidents. 98% response rate. No results on effectivity. Application of measures give indication on perceived usefulness of recommendations and feasibility of recommendations.
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Nau et al
46
| 63 nursing students attending training course, Germany | Level 5 Very low | Longitudinal pretest and post-test study The development and testing of a training course in aggression for nursing students |
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Schat and Kelloway35
| Healthcare setting 225 employees in healthcare | Level 5 Very Low | Organisational support: reducing adverse consequences of workplace aggression Survey, moderated multiple regression | Secondary prevention: moderating effect of organisational support: instrumental support (eg, support from co-workers) and informational support (eg, training) on negative consequences of workplace aggression and violence |
Fear of future violence Emotional well-being Somatic health scale Job-related affect Job neglect
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Instrumental support: positive effect on variance of (3%–6%) : emotional well-being, somatic health, job-related effect. No effect on fear of future violence and job neglect (very low). Information support: positive effect on variance of (3%–6%) emotional well-being, no effect on other outcomes (very low). No effect on: fear of future violence and job neglect.
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Ifediora
23
| General practice, Australia, 300 doctors of National Home Doctors Service after-hours house call services | Not applicable | Survey: exploring the safety measures by doctors on after-hours house call services |
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Hills and Joyce47
| Australia, clinical medical practice, 9449 doctors of which 3515 GPs | Not applicable | Cross-sectional study, self report survey of implementation of 12 prevention and minimisation actions MABEL Survey | No report on effectivity of measures. Implementation of recommendations:Policies, protocols for aggression prevention and management: 66%. Warning signs in reception: 49%. Alerts to high risks of aggression: 52%. Restricting or withdrawing access to services for aggressive persons: 45%. incident reporting and follow-up: 68%. Education & training: 53%. Alarms : 47%. Clinician escape: 23%. Optimised lighting, noise level, comfort and waiting time in waiting area: 52%. Patient access restriction: 62%. Building security system: alarm, camera, and so on: 70%. Safety measures for after-hours on-call work or home visits: 34%.
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Geoffrion et al
33
| 1141 healthcare workers and law enforcers, Canada, GEN | Not applicable | Survey: individual and organisational predictors of trivialisation of workplace violence among healthcare workers and law enforcers. | |
Normalisation of violence as being ‘part of the job’ Taboo: avoiding open discussion, fear of being stigmatised as incompetent
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Discussion on under-reporting. Individual factors in healthcare: Men are more likely than women to consider workplace violence as part of the job (34% vs 23%) and perceived a taboo (54% vs 42%). Staff with more than 15 years of work experience are more likely to tolerate workplace violence as part of the job. Organisational factors: colleague and employer support, training, zero tolerance policy contribute to normalisation of violence but decrease the likelihood of taboo.
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