Dr. Arnold Merriam, second from right, was recognized for the Violence Prevention Program, with (l. to r.) Laray Brown, HHC Senior Vice-President; William Walsh, North Bronx Network Senior Vice-President; and former HHC executive Lorraine Tredge.

Aggressive behavior can be a symptom of mental illness and is a common occurrence during psychiatric hospitalization.  But an award-winning Violence Prevention Program at Jacobi Medical Center and North Central Bronx Hospital has found a way to treat high-risk patients more effectively, making the inpatient units safer and calmer by preventing violence before it starts.

“We have armed our staff with a comprehensive awareness of patients’ violence potential and a deeper understanding of therapeutic options to reduce danger to patients and staff and promote faster recovery,” said Dr. Arnold Merriam, Chairman of Behavioral Health Services for the North Bronx Healthcare Network, which includes both hospitals. “With this approach, we have proven that a highly structured program to assess and manage violence prone patients can be successfully implemented in an urban inpatient psychiatric facility.”

Patients with a past pattern of violence and a score of 2 or higher on the assessment tool called the “Broset Violence Checklist” are enrolled in the program, given a more detailed evaluation, and a specialized individual treatment plan.  The assessment identifies factors that precipitate the patient’s aggressive behavior, calming measures that help the patient regain self-control, as well as the patient’s preference for medications and a discussion of the use of seclusion or restraint if other measures fail.

The program has had impressive results. The most recent data shows that in the time period from July 2009 to June 2010, injuries to patients and staff decreased by 25 percent compared to July 2008 to June 2009. And the reduced level of violent behavior has diminished the reliance on seclusion and restraint.

In fiscal year 2010, Jacobi Hospital behavioral health cared for 1,310 inpatients, had 22,005 outpatient visits and 5,228 emergency visits. North Central Bronx cared for 920 inpatients, and had 17,766 outpatient visits and 3,231 emergency visits.

"The Violence Reduction Protocol success rates demonstrate that it is possible to design programs with effective proactive interventions that help protect our patients from harm, without compromising the safety of our staff," said William Walsh, Senior Vice President of the North Bronx Network. 

“Maintaining safety through the use of seclusion and restraint measures is increasingly considered anti-therapeutic, a potential abuse of patient rights, and an indication that the appropriate treatment efforts have failed,” said Dr. Merriam.

Brightly colored medical record tags for patients in the program and notification on white boards that are only visible to staff have also helped to increase communication among the providers, and from shift to shift.

“These simple measures presented a visual form of staff communication.  And we know that better communication is key to patient safety,” added Dr. Merriam.

October 2010