Preventing aggression in a pediatric inpatient unit: a best practice implementation project.

Introduction: In pediatric inpatient settings, there has been an increase in patients with mental health problems who display aggressive behavior toward staff.

Aim: The aim of this project was to prevent aggression in patients in a pediatric inpatient unit through the promotion of best practices.

Methods: The project was guided by the JBI Model of Evidence-Based Health care and the JBI Evidence Implementation Framework. An audit and feedback strategy was used, with baseline and follow-up audits conducted. Eight evidence-based practices were used for the audit criteria. Strategies to improve compliance with best practices were implemented following the baseline audit. A follow-up audit was conducted to measure any changes in clinical practice.

Results: Gaps between evidence and practice were identified for three of the audit criteria. Barriers included the lack of a policy for preventing or managing aggressive behavior in patients, the lack of a process to identify triggers of aggressive behavior, and inconsistent use of the aggression prevention care plan in the electronic health record. To address these barriers, the project team created a unit protocol, or written guidance, for preventing aggressive behavior, implemented a process to document triggers, and developed a general aggression care plan in the electronic health record. Overall compliance with evidence-based practices increased from 30% to 34%.

Conclusions: This evidence implementation project used a clinical audit process, which led to a small overall improvement in compliance with evidence-based practices. This project has a potential long-term benefit, with staff being better prepared to prevent aggressive outbursts in patients in the general pediatric unit. However, further work is required to continue improving compliance with evidence-based practices.

Spanish abstract: http://links.lww.com/IJEBH/A358.