Reducing aggression in the haemodialysis unit by improving the dialysis experience for patients

The haemodialysis nurses at St Georges Hospital chose to address the problem of aggression in the dialysis unit as their \u27Models of Care\u27 project. Aggression had been a long-standing problem in the dialysis unit and the nurses perceived that the amount of aggression had increased by felt powerless and unsupported to address this. Method: Baseline data was collected using: Incident Information Management System (IIMS) data, that is, the online system used by the hospital to report any type of incident; the Aggression Grading Record of Observation (AGRO) score data; process mapping; patient satisfaction surveys; and staff satisfaction surveys. Two simple strategies of standardised communication were implemented for three months: an illustrated flyer outlining realistic waiting times and a system of nurse to patient allocation. After three months the number of aggressive incidents was remeasured and compared with the baseline. Results: The baseline incidence of aggressive episodes recorded using the AGRO score was found to be between 2% and 8% of all treatments. Common reasons for aggression included: waiting times (52%), mental health issues (17%), environmental issues (11%) and treatment conflicts (11%). After implementing the strategies for three months, data was collected again. The incidence of aggression dropped to less than 2% for the first two weeks and to less than 1% for the last two weeks of data collection. Conclusion: Through the use of effective, standardised communication it is possible to reduce the incidence of aggressive episodes to \u3c1% of dialysis treatments