Multidisciplinary Protocol for the Management of Violent Patients and Promotion of Workplace Safety in the Intensive Care Unit

Introduction: Workplace violence is a prevalent issue in healthcare, yet limited evidence informs management options to improve workplace safety associated with violent patients and families. Even less is known about reducing violence in intensive care units (ICUs), a healthcare setting that commonly serves patients at high risk of aggressive behaviors. Multifaceted, interdisciplinary and institution-specific interventions are recommended to address workplace safety. Methods: Our institution developed four interventions to address the issue of violent patients in our ICUs. The interventions included a Disruptive/Aggressive Behavior Algorithm, Code Grey Box, Rapid Sedation Protocol and a Customer Service Representative. Security calls to the ICUs were the primary measure used to assess effectiveness of the interventions. Results: Security calls to the ICUs decreased from October 2013 to August 2016, after the implementation of the four interventions. Discussion: The implementation of four interventions decreased the calls to security, despite encouraging early escalation to security for potentially violent patients. The trend may represent a decrease in violent episodes, increased staff confidence in managing violent patients, or improved early recognition of high-risk patients. Conclusions: Violent patients and families in the ICU is an understudied workplace safety issue. Our institution used a multifaceted interdisciplinary approach to create and implement interventions which led to a reduction in the need for security personnel response to threats of ICU staff safety. These interventions serve as a guide for other institutions with the aim to decrease workplace violence and promote workplace safety