Update! Alert Systems in use at Royal Perth Hospital (RPH) for Patient Aggression, How they Affect Identified High Risk Staff Groups and Alert Systems in Similar Hospitals.
RPH has a significant organisational and occupational safety and health risk relating to patient aggression. It was recognised that there were significant gaps in how this risk was communicated to staff, in particular those with limited or no access to patient documentation, electronic patient information systems or verbal handover.
The RPH Aggression Prevention and Intervention and Research portfolios undertook a study into systems that alert staff to the risk of patient aggression. This study was supported by grants from the RPH ‘Foundation for Nursing Research’ and ‘Nursing Fellowship’. Key objectives were to identify alert systems in place within RPH, assess their effect on identified high risk staff groups, review current literature and explore alert systems used in similar hospitals.
The study demonstrated an unambiguous evidence base supporting aggression risk alert systems and the governance required to support these. Recommendations were made to increase the opportunities to communicate/alert staff to the risk of patient aggression through clinical documentation, referral systems, electronic patient information systems and the use of visual risk alerts. The key priority was to develop the governance around the use of alert systems prior to their introduction to ensure the aggression risk alert process was fair and lawful, objective, based on a specific incident(s) and risk assessment and that there was clearly defined criteria, authorisation and review process. The governance process also needed to explore the issues around open disclosure, informing and when not to inform patients that they have an alert specific to aggression.
The recommendations from the study had the potential to alert every RPH staff group of potential risk, facilitating their ability to implement risk reduction measures, potentially preventing or reducing the consequence of patient initiated aggression.
Significant progress has been made in the two years following the report and recommendations. Most notable is the introduction of signage designed to visually alert staff to the risk of patient aggression. These alerts are yellow and black magnets on the patient journey board and yellow and black signs on the entrance to single patient rooms or above the patient’s bed space within shared rooms. The governance around the use of the visual alerts is underpinned by a standard operation procedure which includes criteria for use, authorisation, review, open disclosure and safe systems of work and is supported by education.
A recent survey has been undertaken to audit the visual alerts against the SOP and a further survey is planned to assess the effect of the alerts on the original identified staff groups. Anecdotally, feedback from clinical and non-clinical staff indicates that the visual alerts assist them in identifying risk and offers opportunity to seek a verbal handover as to the risk behaviours, triggers, relievers and required precautions. One other notable improvement in regards to the visual alerts is that any patient with a visual alert must have a nurse escort during any inter hospital transfer, again improving the opportunity for verbal handover of risk.
In regards to clinical documentation, communicating the risk of aggression has improved with the review of the ED Triage form to include a section relating to behaviour in the ward handover section of the form.
In regards to electronic patient information systems, there have been some improvements with select ward staff gaining access to the Emergency Department (EDIS) and Mental Health (PSOLIS) risk alerts and ward staff having access to iSOFT handover on patients who are behavioural ‘patient of concern”. A whole of WA Health electronic system is being progressed at a WA Health level following the Health Ministers Summit on Violence. It is anticipated that this will also support the outpatient areas who continue to have very limited communication in regards to aggression.