Abstract
Practice Problem: There is an increased global risk of violence among health workers (WHO, 2023) that may result to physical, emotional, and psychological harm to patients and staff; resulting in emergency room visits, hospitalizations, increased medical costs, and victim mortality (Grossman & Choucair, 2019). Workplace violence (WPV) involving patients, families, and healthcare workers is an escalating public concern (Bellman et al., 2022). Mental health facilities are at a higher risk for the occurrence of safety events (Hawkins & Ghaziri, 2022). The mental health unit had a monthly average of 17.33 incidents in 2022 and 14 occurrences pre-implementation in the adult unit. This quality improvement (QI) project utilized the evidence-based interventions BrØset Violence Checklist (BVC) in an inpatient adult mental health unit to mitigate risks, implement proactive harm reduction strategies, and promote a culture of safety at an urban inpatient adult mental health unit.
Project Aim: To utilize the BrØset Violence Checklist (BVC) in an inpatient adult mental health unit to decrease the incidence of safety events.
Methodology: The Knowledge to Action (KTA) translational science model provided a framework for the QI project. A pre-and post-intervention design was used to investigate the impact of the BVC tool on safety events in an urban, 25-bed capacity, adult inpatient mental health unit. All participants were aged 18 years old and above. The child/adolescent unit was excluded from the QI project. The project involved nursing staff education and implementation of the BVC tool between July and September of 2023.
Data collected include process measures (BVC tool compliance) and outcome measures (BVC score, safety events, and de-escalation intervention). The BVC is a six-item behavioral screening tool that that include confusion, irritability, boisterousness, physical threats, verbal threats, and attacks on objects. A point is assigned for each behavior exhibited and scores are interpreted as high (3-6), moderate (1-2), or low (0) risk for violence within the next twenty-four hours. The data from the BVC risk assessment allows for an opportunity to implement and reinforce proactive measures to prevent impending violence (Dickens et al., 2020; Gautam et al., 2023).
Results: There were 17 nurses trained and 126 patients screened. All nurses demonstrated competency in the use of the BVC tool. Patients scoring 2 or greater on the BVC tool received structured interventions aimed at de-escalation. Results demonstrate a decrease in the number of documented safety events.
Limitations: The study is limited to one adult inpatient mental health facility.
Conclusions/Implications for Practice: Results indicate that the BVC tool is effective in reducing the occurrence of safety events in an adult inpatient mental health unit. Findings from the quality improvement project will be used to lead change including the development of policy and procedures specific to the implementation of the BVC tool, continued outcome evaluation, and ongoing education on de-escalation interventions. A recommendation to the institution includes further analysis of BVC use in additional units.
Notes
Presenter notes available in attached slide deck.
References: Almvik, R. (n.d.). Brøset violence checklist. https://www.risk-assessment.no/
Bellman, V., Thai, D., Chinthalapally, A., Russell, N., & Saleem, S. (2022). Inpatient violence in a psychiatric hospital in the middle of the pandemic: Clinical and community health aspects. AIMS Public Health, 9(2),342–356. . https://doi.org/10.3934/publichealth.2022024
Grossman, D.C. & Choucair, B. (2019). Violence and the US health care sector: Burden and response. Health Affairs, 38(10), 1638–1645. https://doi.org/10.1377/hlthaff.2019.00642
World Health Organization. (2023). Preventing violence against health workers. https://www.who.int/activities/preventing-violence-against-health-workers
Dickens, D.L., O’Shea, L.E., & Christensen, M. (2020). Structured assessments for imminent aggression in mental health and correctional settings: Systematic review and meta-analysis. International Journal of Nursing Studies, 104, 103526–103526. https://doi.org/10.1016/j.ijnurstu.2020.103526
Gautam, M., Yadav, K. S., Chaudhary, J., & Jain, A. (2023). Clinical practice guidelines for assessment and management of aggressive and assaultive behavior. Indian Journal of Psychiatry, 65(2), 131–139. https://doi.org/10.4103/indianjpsychiatry.indianjpsychiatry_518_22
Hvidhjelm, J., Berring, L.L., Whittington, R., Woods, P., Bak, J., & Almvik, R. (2023). Short-term risk assessment in the long term: A scoping review and meta-analysis of the Brøset violence checklist. Journal of Psychiatric and Mental Health Nursing. https://doi.org/10.1111/jpm.12905
Lockertsen, O., Varvin, S., Færden, A., Eriksen, B. M. S., Roaldset, J. O., Procter, N. G., & Vatnar, S. K. B. (2020). Risk assessment of imminent violence in acute psychiatry: A step towards an extended model. The Journal of Forensic Psychiatry & Psychology, 31(1), 41–63. https://doi.org/10.1080/14789949.2019.1663898
Moursel, G., Cetinkaya Duman, Z., & Almvik, R. (2019). Assessing the risk of violence in a psychiatric clinic: The Brøset violence checklist (BVC) Turkish version—validity and reliability study. Perspectives in Psychiatric Care, 55(2), 225–232. https://doi.org/10.1111/ppc.12338
Sammut, D., Hallett N, Lees-Deutsch L, & Dickens G.L. (2022). A systematic review of violence risk assessment tools currently used in emergency care settings. Journal of Emergency Nursing. https://doi.org/10.1016/j.jen.2022.11.006
Sigma Membership
Gamma Kappa
Type
Presentation
Format Type
Text-based Document
Study Design/Type
Other
Research Approach
Translational Research/Evidence-based Practice
Keywords:
Mental Health Services, People with Mental Illness, Risk of Violence, Behavioral Alerts, Broset Violence Checklist, Violence -- Prevention and Control
Recommended Citation
Bernardo, Maritess B. and Mann, Catherine, "Impact of Brøset Violence Checklist on Safety Events in a Mental Health Unit" (2026). Creating Healthy Work Environments (CHWE). 65.
https://www.sigmarepository.org/chwe/2024/presentations_2024/65
Conference Name
Creating Healthy Work Environments
Conference Host
Sigma Theta Tau International
Conference Location
Washington, DC, USA
Conference Year
2024
Rights Holder
All rights reserved by the author(s) and/or publisher(s) listed in this item record unless relinquished in whole or part by a rights notation or a Creative Commons License present in this item record. All permission requests should be directed accordingly and not to the Sigma Repository. All submitting authors or publishers have affirmed that when using material in their work where they do not own copyright, they have obtained permission of the copyright holder prior to submission and the rights holder has been acknowledged as necessary.
Review Type
Abstract Review Only: Reviewed by Event Host
Acquisition
Proxy-submission
Date of Issue
2026-02-20
Impact of Brøset Violence Checklist on Safety Events in a Mental Health Unit
Washington, DC, USA
Practice Problem: There is an increased global risk of violence among health workers (WHO, 2023) that may result to physical, emotional, and psychological harm to patients and staff; resulting in emergency room visits, hospitalizations, increased medical costs, and victim mortality (Grossman & Choucair, 2019). Workplace violence (WPV) involving patients, families, and healthcare workers is an escalating public concern (Bellman et al., 2022). Mental health facilities are at a higher risk for the occurrence of safety events (Hawkins & Ghaziri, 2022). The mental health unit had a monthly average of 17.33 incidents in 2022 and 14 occurrences pre-implementation in the adult unit. This quality improvement (QI) project utilized the evidence-based interventions BrØset Violence Checklist (BVC) in an inpatient adult mental health unit to mitigate risks, implement proactive harm reduction strategies, and promote a culture of safety at an urban inpatient adult mental health unit.
Project Aim: To utilize the BrØset Violence Checklist (BVC) in an inpatient adult mental health unit to decrease the incidence of safety events.
Methodology: The Knowledge to Action (KTA) translational science model provided a framework for the QI project. A pre-and post-intervention design was used to investigate the impact of the BVC tool on safety events in an urban, 25-bed capacity, adult inpatient mental health unit. All participants were aged 18 years old and above. The child/adolescent unit was excluded from the QI project. The project involved nursing staff education and implementation of the BVC tool between July and September of 2023.
Data collected include process measures (BVC tool compliance) and outcome measures (BVC score, safety events, and de-escalation intervention). The BVC is a six-item behavioral screening tool that that include confusion, irritability, boisterousness, physical threats, verbal threats, and attacks on objects. A point is assigned for each behavior exhibited and scores are interpreted as high (3-6), moderate (1-2), or low (0) risk for violence within the next twenty-four hours. The data from the BVC risk assessment allows for an opportunity to implement and reinforce proactive measures to prevent impending violence (Dickens et al., 2020; Gautam et al., 2023).
Results: There were 17 nurses trained and 126 patients screened. All nurses demonstrated competency in the use of the BVC tool. Patients scoring 2 or greater on the BVC tool received structured interventions aimed at de-escalation. Results demonstrate a decrease in the number of documented safety events.
Limitations: The study is limited to one adult inpatient mental health facility.
Conclusions/Implications for Practice: Results indicate that the BVC tool is effective in reducing the occurrence of safety events in an adult inpatient mental health unit. Findings from the quality improvement project will be used to lead change including the development of policy and procedures specific to the implementation of the BVC tool, continued outcome evaluation, and ongoing education on de-escalation interventions. A recommendation to the institution includes further analysis of BVC use in additional units.
Description
This activity provides information on the use of a simple six-item evidence-based intervention in predicting the occurrence of violence among patients with mental health problems. The Brøset Violence Checklist (BVC) uses patient observation to proactively mitigate violent behavior and hence will promote patient and staff safety.