Date of Graduation

Spring 5-21-2021

Document Access

Restricted Project/Capstone - USF access only

Degree Name

Master of Science in Nursing (MSN)


School of Nursing and Health Professions

First Advisor

Dr. Robert Patterson


Problem: Behavioral health patient presentation to the emergency department has been on the rise, resulting in increased rates of violence and abuse towards staff. A few instances have been related to improper safety checks, or checks being not completed at all.

Context: ED X is located in a Northern California urban city. Behavioral health patients presenting to the ED has increased in recent years. Nurses have expressed that with this increase there are increased risks of agitation, abuse, and violence towards staff.

Interventions: The electronic healthcare record hosts an existing behavioral health safety checklist, referred to as a precautions checklist, which staff was unaware of. Interventions focused on educational tools to create awareness and understanding of the tool, including how-to guides and walkthrough videos.

Measures: Data capture was focused on two primary measures: completion of the precautions checklist for indicated patients and completion of the checklist routinely as recommended. Additional surveying of staff is needed to understand perception of usefulness and effectiveness of the safety checklist in caring for patients and mitigation of violence risks.

Results: Documentation rates using the precautions checklist prior to implementation was 4%. Upon educational tool implementation, usage of the checklist increased to 38%.

Conclusions: Implementation of educational tools for use on precautions checklist proved successful as determined by increase in documentation use. There are opportunities for future improvement in caring for behavioral health patients, such as use of crisis intervention training or behavioral health focused handoff report.

Keywords: behavioral health, agitation, violence, assault, safety, precautions

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