The dynamic appraisal of situational aggression.

Abstract

Reducing incidents of aggression through the use of a structured risk assessment tool in a secure extended care setting. Recently the demographics of patients in the Secure Extended Care Unit (SECU) have changed to include a complex population with potential for harm to others. A structured clinical risk assessment tool, the Dynamic Assessment of Situational Aggression (DASA) was implemented in the SECU with the aim to: 1) Improve staff skills to identify and respond effectively to patients with a risk of aggression 2) Evaluate implementation of the DASA. Seclusion and VHIMS data for 2 patients with identified risk of harm to others was compared six months pre and post DASA implementation. The same data and time period was also compared for the entire ward. Staff confidence in using the DASA was measured through a Likert Self Rating Scale. Analysis of VHIMS data shows a reduction in the number of moderate and mild incidents and seclusion episodes since the introduction of the DASA. Staff questionnaire showed an increase in each DASA skill item and overall skill score between pre and post training. The use of a structured risk assessment tool has reduced the subjectiveness of conducting risk assessments with complex and volatile patients. Use of the DASA has assisted staff to assess objectively and intervene with a targeted proactive response.