Taking charge of escalating violence

Patients and staff alike, fear when a patient loses control. Violent behavior may result from intoxication with substances, schizophrenia, disordered or paranoid thoughts and anger control problems.

Generally violent behavior does not occur without warning. Agitated patients may show disorganized thinking and behavior. They may be hyperactive, such as pacing in an effort to control their tension. They may speak loudly, be demanding and act fearful. They may sigh and breathe more rapidly. They may swear, make sarcastic comments or attempt to intimidate others.

It is key to try to reduce the risk of violence.

Attorneys may become involved in a case of a violent psychiatric patient that resulted in injury to the patient or others.

At Med League, we are aware of patients who have been tackled by security guards or sat on by staff (and smothered).

Techniques to Control Behavior Without Seclusion and Restraints or Injury

Protecting patients, staff and the environment requires a proactive approach. Here are some techniques that have proven to be useful and define the standard of care for reacting to a potentially volatile situation:

• Identifying the risk factors associated with violence and use them to assess the risk for a specific patient.
• Anticipating and intervening early to prevent a crisis.
• Appropriately ordering medications and using them before the patient’s behavior escalates.
• for staff to be recognizing how their behavior can influence the behavior of others.
• Identifying behaviors in the patient that are relevant for transitioning to a community setting.
• Reinforcing the positive behaviors.
• Helping the patient identify preferred alternatives to violence for dealing with feelings.

Managing a Violent Patient

The first priority is to prevent injury to the patient, and other staff members and patients. Here is what staff should be taught to do.

• Get help. Don’t approach the patient alone.
• Don’t allow themselves to be trapped away from an exit. Stay between the patient and the doorway.
• Don’t get close to the patient.
• Keep the patient within view.
• Scan the environment for dangerous objects.
• Don’t turn their back on an agitated patient.
• Keep bystanders away from the scene.
• Give simple directives and praise the patient if he does what they ask.
• Speak calmly and softly.
• Don’t tell him to calm down; this could cause further agitation. Ask him to define what would help him calm down.
• Be courteous and frequently say “please” and “thank you”.

Staff members can avoid harm to the patient, themselves and others by proactively addressing escalating behavior and taking charge when violence erupts.

Med League provides medical expert witnesses to trial lawyers. Please call us at (908)788-8227 or contact us today to discuss your next case.