Violence
Assessing Risk Factors for Violence
Dynamic | Static | |
|---|---|---|
Homicidal plan | Past crime/violence | |
Weapon access | Impulsivity | |
Drug intoxication | Antisocial/borderline | |
Command auditory hallucinations | Childhood abuse (e.g., violence at home) | |
Paranoid delusions | Disinhibition secondary to delirium/dementia | |
Premeditated/chronic | Male ages 15-24 | |
Presence of a victim | ||
Frequent and open threats | ||
Concrete plan | ||
Visible agitation | Early loss of parent | |
Mania | Current suicidal behavior/history of suicide attempts | |
General Considerations for Evaluation and Management of an Agitated Patient
Quick search of patient for potential weapons upon arrival in unit.
Consider and attempt to rule out any medical etiology for agitation necessitating urgent management (e.g., delirium tremens).
Maintain the safety of the patient, staff, and other patients at all times.
Monitor closely for signs of pre-escalation, such as:
Pacing
Verbal threats
Appearance of escalating psychotic symptoms
In the presence of escalating agitation, assemble adequate trained personnel prior to speaking with patient.
Attempt to de-escalate patient by offering oral medication and/or offering a voluntary time out in a quiet, secluded area.
While speaking with the patient, avoid direct eye contact and address patient in a nonprovocative manner.
Maintain a nonthreatening posture and safe distance from the patient.
Before approaching patient, check for any items that can potentially be used as weapons (e.g., pens, ties).
Clearly explain procedure to patient, that he or she will not be harmed, and its necessity for maintaining everyone’s safety.
Allow the patient to walk to the seclusion area voluntarily before escorting forcefully.
Monitor patient closely and be prepared to administer emergent IM medication and perform restraint in the event of violent behavior.Related posts:
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