Implementation of the Brøset Violence Checklist for Adult Psychiatric Patients

Violence has become an increasing issue in healthcare systems worldwide, especially in inpatient psychiatric units. Violence can lead to harmful effects for patients and staff members and has been shown to increase the risk of depression, anxiety, and suicide. Additionally, violence has been shown to lead to staff burnout, which in turn leads to poorer patient outcomes. This project aimed to decrease rates of violence by implementing the Brøset Violence Checklist (BVC), a screening tool that predicts imminent violence. The BVC is a six-item checklist that allows patients to be scored based on behaviors. Then, a sum score is produced, and recommended interventions are available. The BVC was used to score patients once each shift and on admission at two psychiatric facilities in the southern United States. Baseline data was collected for the two months prior to the implementation period and compared to data from the implementation period, which lasted two months. Data variables collected included demographics, admission diagnosis, number of violent incidents per patient, the shift that the BVC was completed on, the sum of the BVC score, and interventions that occurred. Ultimately, there was no statistically significant difference in the rate of violent incidents in the pre-implementation period versus the implementation period. However, the BVC still showed some promise. Of the individuals who had at least one violent incident, at facility one, there was a statistically significant decrease in the number of violent incidents per patient from the pre-implementation period to the implementation period. Additionally, at facility two, there was a practically significant decrease in the use of restraints and seclusion. The use of a structured risk assessment tool, such as the BVC, has shown potential for reducing violence much more effectively than chance alone.