Successful “3S” Strategies to Translate and Implement Evidence on the Management of Disturbed, Aggressive and Violent Patients (DAV) in a Mental Health Hospital

Tuesday, 13 July 2010: 4:05 PM

Premarani Kannusamy, PhD, RN
Nursing, Institute of Mental Health, Singapore, Singapore

Learning Objective 1: The learner will be able to 1. use a simple 3S model to implement EBP in the management of DAV patients.

Learning Objective 2: 2.identify barriers and articulate key factors for implementation of EBP

Search for the Clinical Problem Using the PICO format, the clinical problem was “will the use of clinical practice guidelines on the management of DAV patients (I) versus traditional methods of management of DAV patients (C) , reduce the number of patient to patient and patient to staff assaults and restraints per month (O) at the mental health hospital. Search for the Evidence A systematic review was done, which resulted in the development of Clinical Practice Guidelines for management of DAV patients. Strategies to translate and implement EBP The author and a team comprising APN and nurses implemented the following to manage DAV patients:
  • Conducted hands-on-workshop and lunch time road shows on implementation of EBP;
  • Designed a one page algorithm with 3 protocols merged into one evidenced based nursing protocol;
  • Used the Fremantle Acute Arousal Scale for assessment
  • Implemented evidence based interventions de-escalation, ventilation, redirection, time-out and a PRN regime of rapid tranquilisation and physical restraints aimed to prevent disturbed behaviours and reduce the risk of violence.
Results: There was a significant reduction in the number of assaults from 8.9 per 10,000 patient days to 3.5 per 10,000 patient days. The use of restraints also decreased from 35 to 15 per month and the duration decreased from 8 to 4 hours. Conclusion: The outcome of using an evidence-based approach to change current practice in the management of DAV patients has been positive. Roger’s (1995) theory on the diffusion of innovations was used to achieve outcomes.