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Abstract
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In this issue of The Joint Commission Journal on Quality and Patient Safety, DeSanto Iennaco and colleagues1 present "The Aggressive Incidents in Medical Settings (AIMS) Cohort Study," based on a novel tool developed to improve accuracy for measuring the incidence of, impact of, and factors that may precipitate workplace violence against healthcare workers. Decades of retrospective research have identified violence perpetrated by a patient or family member against a healthcare worker as the primary cause of assault and battery in the industry.2 Obtaining unbiased workplace violence data has proven difficult, and many barriers have been identified that limit reporting and impair accuracy. Compounding this has been the failure to adopt universally accepted definitions of what constitutes verbal and physical violence across different settings and institutions. Studies to measure healthcare workplace violence rely almost exclusively on bias-prone retrospective surveys, limiting reliability. These factors make the comparative analysis of data from individual studies imprecise, at best.
Mathematical physicist William Thomson, also known as Lord Kelvin, wrote in 1883, "I often say that when you can measure what you are speaking about, and express it in numbers, you know something about it; but when you cannot measure it; when you cannot express it in numbers, your knowledge is of a meager and unsatisfactory kind; it may be the beginning of knowledge, but you have scarcely, in your thoughts, advanced to the stage of science, whatever the matter may be."3 Lord Kelvin would be pleased with this study as it has advanced to the stage of science. The authors successfully endeavored to collect prospective data in real time on verbal and physical incidents of violence, called "aggressive events" in this study, against registered nurses (RNs) and patient care assistants (PCAs). The study is unique in that it uses prospective data collection methods across multiple sites using a standard definition and two reporting processes.
Briefly, the study uses a physical counting device worn by participating staff during their shifts to capture violent occurrences in real time. During and after the shift, each participant transposed those recorded events into the proprietary Aggressive Incident Management Log (AIM-Log) form to collect standardized details and demographics on the event and those involved. Two important prospective measurements were designed and reported: The "patient aggression rate" provides the number of recorded verbal and physical events against participants divided by the number of total patient-days on the unit. Because not every worker is exposed to each act of violence, the authors also measured the number of incidents to which individual participants were exposed per 40 hours of work performed on the unit, equal to a standard American work week. Importantly, this was not a single-site study but instead was performed at five similar inpatient medical units from two hospitals--one community hospital and one large academic hospital. Aggressive events were recorded during 22.7% of shifts, often with multiple events per shift. Each unit reported at least 2.5 aggressive events per day with a ratio of verbal to physical events of nearly 2:1. ...
Language: en |