Triggers, Responses, and Outcomes for Patient Related Violence and/or Aggression Events During Acute Hospitalisation: A Documentary Analysis.
Debra Kerr, Alison M Hutchinson, Elisa Ilarda and 8 others
PMID 41933441WHAT IT FOUND
Acute ward Code Grey calls for patient aggression were often triggered by agitation, wanting to leave, wandering and confusion.
Physical and chemical restraint were common responses, while reported injuries were few.
Key findings
01Code Grey incidents were commonly triggered by agitation, wanting to leave, wandering and confusion, and often involved physical violence or verbal aggression.
02Physical restraint was reported more often in the prospective period than the retrospective period, and chemical restraint was used in both periods.
03When the Broset Violence Checklist was completed, confusion and irritability were common, but completion differed markedly between sites.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
Only two hospital sites in Victoria were studied, so findings may not apply elsewhere. Documentation in incident reports and medical records was sparse, especially about triggers and behaviour types. Retrospective and prospective data collection methods differed, which may affect comparison between periods. Prospective data collection was limited to one weekday per week during business hours, potentially introducing bias. No formal sample size calculation was performed because the study was not designed to test a hypothesis. Staff injuries may be under-reported, and incident reports may lack important details. Broset Violence Checklist completion processes differed between sites, so risk assessment coverage was inconsistent.
Declared interests
The authors declare no conflicts of interest. The study received non-competitive internal grants from the Department of Nursing and Midwifery at one participating health service and the partnering academic institution.
The easy way to misread this
Do not read the high rate of physical and chemical restraint as evidence that restraint was effective or necessary. This study describes documented responses to Code Grey incidents; it did not test whether restraint reduced harm.