Margaret Pearce is the CNO for the University of Utah Health system and has served as VP of patient services/CNO for hospitals and systems across the United States since 1994. Her academic preparations include BSN, MSN, MBA, and PhD degrees.

Laura Adams is a senior Nursing Director for University of Utah Health and has served in senior-level nursing leadership roles for organizations across the United States since 1990. Her academic preparations include ADN, BSN, and MSN degrees. 

 

Background: Patient aggression toward nurses has become more common within inpatient hospitals, posing serious safety risks because this environment is less secure and possesses nurses who are less prepared to address patient aggression. For example, knowledge and coordination gaps in de-escalation practices were present at the university health system of this project among clinical teams, hospital security, and the police.

Purpose: The purpose of this quality improvement initiative was to increase the safety of inpatient clinical encounters by fostering interdisciplinary teamwork and creating a formal program for de-escalating aggressive patients.

Methods: A partnership between nursing, hospital security, and police was to be fostered by having these teams collaborate to design the project, train staff, and participate in de-escalation teams. Best practices for deescalation were surveyed, the program was designed, IRB approval was obtained, and implementation occurred in two pilot areas. Project measures included feedback from pretest and posttest questionnaires.

Outcomes: Baseline survey responses from inpatient nurses indicated a lack of knowledge and resources for patient de-escalation; participant ranking of both knowledge and resources increased after trainings and program implementation. Teamwork and collegiality between nursing staff, hospital security, and police also increased.

Conclusions: With patient aggression on the rise within inpatient hospitals, it is urgent to develop systems for safely managing aggressive patient encounters. Deescalation trainings are an essential component of a comprehensive strategy to manage patient aggression. By sharing project objectives, methods, and outcomes, the hope is to support healthcare givers in worldwide institutions to create like programs.