Usefulness of Aggressive Behaviour Risk Assessment Tool for prospectively identifying violent patients in medical and surgical units

Aim. The aim of this study is to evaluate the usefulness of the Aggressive Behaviour Risk Assessment Tool for prospectively identifying violent patients in medical-surgical units. Background. Although patient violence against nurses is a serious occupational hazard, there is a lack of simple screening tools with acceptable sensitivity and specificity for identifying potentially violent patients in medical-surgical units. Methods. A prospective cohort study involving patients admitted to six medical-surgical units at an acute care hospital was conducted from August 2009 to December 2009. Primary nurses completed the 17-item checklist within 24 hours of admission. A second identical checklist was completed by another nurse to assess the inter-rater reliability. Following a violent event or just prior to discharge, the violent event outcome section was completed to collect information about violent event, if any. A multivariate logistic regression model with backward elimination was used to select a set of parsimonious items that best predict violent behaviours. Results. Fifty-six patients out of 2063 (2.7%) had one or more violent events. A parsimonious set of ten items were selected for the tool. Receiver Operating Characteristics analysis of Aggressive Behaviour Risk Assessment Tool showed that the area under the curve was 0.82 (95% Confidence Interval, 0.750.90). The sensitivity and specificity at the cut-off score of 1 were 70.9% and 89.3%, respectively. The Cohens Kappa for inter-rater reliability was 0.647. Conclusion. The Aggressive Risk Assessment Tool is a simple, easy-to-use assessment tool with acceptable inter-rater reliability, sensitivity and specificity that may be useful for prospectively identifying violent patients in medical-surgical units.