1. DeSouza, Fabio DNP, RN, CPHQ, CPPS
  2. Bleich, Michael PhD, RN, FNAP, FAAN


Background: The impact of aggressive and violent behaviors directed toward staff in psychiatric facilities has layers of implications tied to recruitment and retention, cost, quality and safety.


Local Problem: Increased patient aggressive behaviors contributed to staff dissatisfaction and high turnover rates, triggering an analysis of current aggression management approaches.


Methods: The Plan-Do-Study-Act quality improvement method was used for this project.


Interventions: The Dynamic Appraisal of Situational Aggression (DASA) risk assessment tool was implemented.


Results: Daily aggression risk identification increased by 69%, and aggressive incidents toward staff and patients decreased by 64% and 28%, respectively, when the tool was completed more consistently. Surveys revealed acceptance of the tool by nurses.


Conclusions: Quality improvement statistical tools supported evidence-based strategies. A risk for aggression assessment laid the foundations for implementing strategies for reducing aggression and violence.