Prevalence of physical violence in a forensic psychiatric hospital system during 2011–2013: Patient assaults, staff assaults, and repeatedly violent patients

IntroductionWe examined physical violence in a large, multihospital state psychiatric system during 2011–2013, and associated demographic and clinical characteristics of violent patients to better understand issues of patient and staff safety.MethodActs of physical violence committed by patients against other patients (n=10,958) or against staff (n=8429) during 2011–2013 were collected and analyzed for all hospitalized patients during the same time period to derive prevalence rates and associated odds ratios.ResultsOverall, 31.4% of patients committed at least 1 violent assault during their hospitalization. Differential risk factor patterns were noted across patient and staff assault. Younger age was associated with a higher prevalence of both patient and staff assault, as was nonforensic legal status. Females had a higher prevalence of staff assault than patient assault. Ethnic groups varied on rates of patient assault, but had no significant differences for staff assault. Schizoaffective disorder was associated with higher prevalence and odds of patient (OR 1.244, 95% CI 1.131 to 1.370) and staff (OR 1.346, 95% CI 1.202 to 1.507) assault when compared to patients diagnosed with schizophrenia. Most personality disorder diagnoses also had a higher prevalence and odds of physical violence. One percent of patients accounted for 28.7% of all assaults. Additionally, violent patients had a significantly longer length of hospitalization.DiscussionImplications of these findings to enhance patient safety and inform future violence reduction efforts, including the need for new treatments in conjunction with the use of violence risk assessments, are discussed.

Using the Violence Prevention Community Meeting Protocol

Assaultive behavior is a serious problem in health care. Nurses, nursing assistants, and other patients increasingly are becoming targets for patient assault. Costs of assaults are high, both in terms of dollars spent and clinical repercussions such as staff injury and lowered morale. This article describes the development of a protocol, in the form of clinical practice guidelines, for a community meeting to decrease assaultive behavior. Implications include use of the guidelines and the need to conduct either a before-and-after study or a comparison of one unit using the intervention with one not using it. There are also questions identified for further study that would test the broad effectiveness of the Violence Prevention Community Meeting guidelines.