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October/November 2016 (vol. 13/3)
Violence de-escalation strategies in acute care
There is a lack of good-quality evidence on the use of violence de-escalation strategies to prevent aggressive behaviour in psychiatric patients in acute healthcare settings, this systematic review finds. It included 29 studies undertaken in acute care settings, such as emergency departments, but excluded trials in long-term psychiatric units. There is low-quality evidence that, compared with ‘usual care’, using risk assessment protocols can reduce both the incidence of aggressive behaviour and the use of restraints or seclusion, but there is insufficient evidence to support a range of other strategies, such as staff training and various medication protocols. Evidence quality was either low or insufficient, with a failure to control properly for potential confounding factors in the 11 controlled trials, and a high risk of bias in the 18 before-and-after intervention studies among the reasons for downgrading the evidence.
Occupational Health at Work October/November 2016 (vol. 13/3) pp40