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WHEN A PATIENT becomes violent, take action quickly to protect the patient, other patients, you, and your coworkers from harm. Know and follow your facility's policy for dealing with a violent patient. Call for help immediately and contact security. Your manager, the patient's healthcare provider, and the facility's risk manager should be informed of the patient's violence once the crisis is diffused.


In the patient's medical record, document exactly what you saw and heard. Start with the date and time the incident occurred, the location, and who was present. Describe the patient's violent behavior and record exactly what you and the patient said in quotes. For example: Pt. throwing books and other items from overbed table to floor. I stated, "I can see you're angry. How can I help you?" Pt. responded, "Try getting me some decent food."


Record your interventions and the patient's response. Document the names of the people you notified and their responses. For example: Dr. Hartwell informed of pt.'s behavior at 1705. Psych. consult ordered. On-call psychiatrist paged at 1708.


Complete an event report, according to your facility's policy. Note any injuries that occurred as a result of the violence to the patient, yourself, and other patients or staff members. Follow facility policy and procedure regarding the care of anyone who sustained an injury.


Healthcare officials and nursing leaders have an ethical and legal responsibility to maintain a safe work environment. Some initiatives they can take include:


* documenting required staff safety and self-protection training provided by the organization for all employees.


* educating staff about proven strategies of intervention for situations of escalating violence.


* stating the organization's expectations for reporting instances of violence or abuse and describing appropriate documentation.


* establishing an ethics committee or other organizational resource for investigating, negotiating, and resolving conflicts.





Evidence-based Nursing Guide to Legal and Professional Issues. Philadelphia, PA: Lippincott Williams & Wilkins; 2009:107.


Complete Guide to Documentation. 2nd ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2008:357-358.