Mitigating Pediatric Inpatient Aggression: A Quality Improvement Initiative. 2022

Amy R Keller, and Rebecca L Kanaley, and Taylor Starr, and Bonnie Strollo, and Michael Scharf, and Sasha Massachi, and Luke Angell, and C Denise Clough, and Jan Schriefer
aGolisano Children's Hospital, Rochester, New York.

Patient aggression in the health care workplace has increased significantly, and the impact of workplace violence can be profound, including psychological trauma and lost productivity. We suspect these safety events are often unreported, leading to missed opportunities to design interventions to reduce harm. The primary aim of the interdisciplinary quality improvement team was to increase staff reporting of safety events utilizing our event reporting system related to the care of verbally and/or physically aggressive pediatric patients by 10% over a 12-month period. An interdisciplinary quality improvement team addressed existing gaps in the care of pediatric inpatients with escalating behavior. Interventions included a survey of staff knowledge, use of the care guideline for management, updates to the electronic medical record, patient aggression screening tool, an electronic order set, and an online education module. The primary outcome measure was the number of reported staff safety events related to the care of aggressive patients. Compliance with the use of the pediatric aggression risk screening tool was tracked as a process measure. The reporting of safety events related to the care of aggressive patients increased from just <1.0 events per 1000 patient days to 3.0 with special cause variation observed on a statistical process control chart. The compliance with the use of the pediatric aggression risk screening tool improved during the time of the project, nearing 90%. A variety of interventions aimed to address pediatric inpatient aggression can improve the reporting of events related to workplace violence and foster a culture of employee safety.

UI MeSH Term Description Entries
D007297 Inpatients Persons admitted to health facilities which provide board and room, for the purpose of observation, care, diagnosis or treatment. Inpatient
D002648 Child A person 6 to 12 years of age. An individual 2 to 5 years old is CHILD, PRESCHOOL. Children
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000374 Aggression Behavior which may be manifested by destructive and attacking action which is verbal or physical, by covert attitudes of hostility or by obstructionism. Aggressions
D017132 Workplace Place or physical location of work or employment. Job Site,Work Location,Work Place,Work-Site,Worksite,Job Sites,Location, Work,Work Locations,Work Places,Work Site,Work-Sites,Workplaces,Worksites
D057286 Electronic Health Records Media that facilitate transportability of pertinent information concerning patient's illness across varied providers and geographic locations. Some versions include direct linkages to online CONSUMER HEALTH INFORMATION that is relevant to the health conditions and treatments related to a specific patient. Electronic Health Record Data,Electronic Medical Record,Electronic Medical Records,Computerized Medical Record,Computerized Medical Records,Electronic Health Record,Medical Record, Computerized,Medical Records, Computerized,Health Record, Electronic,Health Records, Electronic,Medical Record, Electronic,Medical Records, Electronic
D058996 Quality Improvement The attainment or process of attaining a new level of performance or quality. Improvement, Quality,Improvements, Quality,Quality Improvements

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