Twenty-five percent of nurses have reported being assaulted by patients or patients’ family members, according to a three-year study in the American Journal of Nursing. Statistically higher rates of health care violence are reported in emergency department (ED), geriatric and psychiatric settings.

In a new advisory, The Joint Commission summarizes several de-escalation models and provides guidance and resources for managing aggressive or agitated patients in the ED and inpatient settings.

The Joint Commission’s new Quick Safety, Issue 47: "De-escalation in health care" includes techniques health care professionals can apply to reduce aggression and agitation, minimize restraint or seclusion, and ultimately prevent violence or harm to staff.

In addition to providing guidance for health care professionals, the advisory recommends safety actions for health care organizations including:

• Committing resources and time for senior management to educate staff on de-escalation and to ensure time is provided to audit interventions and environmental changes necessary to create the most therapeutic unit possible.
• Using audits to inform practice. The Patient Staff Conflict Checklist (PCC) is cited as an example of a reliable and valid tool for regularly auditing actions that threaten safety and restraint, seclusion or observation.
• Implementing workforce training on new techniques and interventions.
• Incorporating use of assessment tools.
• Involving patients.
• Implementing debriefing techniques.

The Quick Safety is available on The Joint Commission website. It may be reproduced if credited to The Joint Commission.