Standardizing Safety Checks to Decrease Risk for Self-Harm and Violence Among Behavioral Health Patients in the Emergency Department

Introduction Behavioral health patients that present to the Emergency Department (ED) pose a risk for violence that is directed towards themselves or nursing staff. Inconsistent and non-comprehensive safety checks create opportunity for patients to harm themselves or others. At a large urban ED in San Francisco with high volumes of behavioral health patients, no current standardized environmental safety precaution checklist is in place. Methods A standardize environmental safety checklist built into the EPIC, the electronic medical record used at this ED, was presented to staff to complete for patients with presentations that increase risk for self-harm or staff directed violence. A survey was distributed to staff that demonstrated interest in a standardized safety checklist. Post implementation survey results were not yet obtained. After the checklist implementation, concurrent audits were conducted to assess staff compliance. Results Survey of staff demonstrated support for a tool to standardize safety checks for behavioral health patients in this ED. Checklists were completed for 38% of indicated patients during a two-week period, an improvement upon no standardized protocol. Conclusions Continued use of the precautions checklist during a longer period of time will better support and the aim of reducing the risk of violence among patients and violence directed towards staff