Could Hospital Patient Aggression Tool Work in LTC

American researchers led by Son Chae Kim, Professor of Nursing at Point Loma Nazarene University studied more than 2,000 patients admitted to an American acute care hospital over a five-month period. Using a specially designed risk assessment tool within 24 hours of admission was an effective way of identifying which hospital patients in medical and surgical units would become violent. They found that a disproportionate number of elderly patients and males became violent.

The ten-point Aggressive Behaviour Risk Assessment Tool (ABRAT) was completed within 24 hours of admission and revealed that:

• Fifty-six of the 2,063 patients (three per cent) were involved in one or more of the violent incidents. These included 35 episodes of verbal abuse, 26 physical attacks, 15 threats of physical attack, 12 incidents where an emergency call went out to security personnel and three cases of sexual harassment.
• Less than one per cent of the patients with an ABRAT score of zero became violent, compared with eight per cent of the patients with a score of one and 41 per cent of the patients with a score of two or more.
• Half of the violent incidents involved patients aged over 70, despite the fact that they only made up 40 per cent of the patients studied. Males, who made up 48 per cent of the patients studied were almost twice as likely to become violent as females (64 per cent versus 34 per cent).

The five most common predictors of violence were: confusion/cognitive impairment, anxiety, agitation, shouting/demanding and a history of physical aggression.

Researchers concluded that further studies are now needed to see whether the use of the ABRAT can actually reduce violence in clinical settings.

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Tom Raymond