Older people are significantly over-represented in incident data relating to violence and aggression in acute care. Such behaviour that is sometimes labelled as ‘challenging’ can result in poor outcomes for patients, and significant physical harm to patients and staff as well as high levels of stress for patients, relatives or carers and staff.
We analysed the Datix reports filed in our trust over a 12-month period relating to violence and aggression; we excluded incidents from the Emergency Department.
Reviewing the data available to us showed that the majority of incidents relating to violence and aggression in the hospital where the focus of the encounter was patient harms to staff (rather than carer attacks on staff or staff on patients) were significantly biased towards those areas of the acute trust providing care for older people, 77% of incidents.
71% of incidents related to physical violence or aggression directed at staff and 35% involved verbal aggression. 22 % of incidents related to physical or verbal aggression towards another patient and in 12% of cases an implement, such as a walking stick, Zimmer Frame or drip stand were used.
Episodes of violence and aggression directed principally towards staff working in areas providing care for older people are common and likely contribute significantly to the use of sedative medication or antipsychotics, with their associated side effects and complications.
Violence and aggression increases length of stay and has a significantly negative impact on the outcomes of care as well as the experience of care for patients, relatives and staff.
Many instances of potential violence and aggression can be mitigated by the implementation of appropriate, person-centred interventions.
Training in diversion, distraction and de-escalation as well as more technical skills such as methods of physical restraint and self-defense are not routinely taught in general hospitals.
In Doncaster and Bassetlaw Hospitals, we have developed, with our neighbouring mental health trust, a training course for frontline clinical staff which we plan to roll-out across the organisation.