Bed Side Risk Assessments, Part 1

First, let me start by thanking everyone for the well wishes and encouragement. Both here at on my post at LinkedIn. I am very appreciative of the kind words as we get started. Thank you.

One of my passions in violence prevention, and one of the areas I believe shows the most promise, is violence risk assessments. There are a plethora of tools out there, and I want to start off talking about a few of these over the next few weeks.

The first tool I want to discuss is the STAMP tool. The STAMP tool is an observable behavior index that assesses violence risk based off of the assessor’s observations. Specifically the STAMP mnemonic (from which the tool’s name originated) is based on five behaviors: Staring and eye contact, Tone and volume of voice, Anxiety, Mumbling, and Pacing. The thought process behind these five observable behaviors is that the presence of these behaviors represents the potential for violence, and the presence of multiple observable behaviors increases the total risk. For example, someone staring might be disconcerting, but someone staring with threatening tone and anxious pacing could be on the edge of an actual attack.

The goal behind the implementation of a tool like this is that bedside nursing staff would be able to assess the risk of violence at the outset of the visit. The assessment tool would be a regular part of the intake process for every patient. Each element of the STAMP tool is weighted to produce an overall score. Based on the observation, the care provider would be able to immediately have a risk score that would indicate action based on the level. As discussed in the earlier example, a subject that is staring only would rate as a low-level risk, but the combination of elements would raise the level of risk and thus initiate a proactive protocol.

There are other tools out there. I intend to continue this discussion with an overview of the Broset violence checklist, the Aggressive Behavior Risk Assessment Tool (ABRAT), the V-RISK-10, and the Violence Risk Assessment. Each present pros and cons. The STAMP tool is derided as not exhaustive enough, or often producing too many false positives, drawing risk conclusions from too little information. Others tout the assessment as easily administered with high inter-rater reliability. There is evidence to support its effectiveness as a predictive tool. No matter your thoughts on the STAMP tool, the implications of a tool like it are profound. The ability to predict violent behavior allows for true prevention versus traditional reaction.

What are your thoughts? What do you think about the potential of combining a bedside nursing assessment that predicts violence with a proactive security response? Are you aware of other violence risk assessments out there with demonstrated effectiveness? I look forward to hearing from you, and to continuing the conversation.


References:

Luck, L., Jackson, D., Usher, K. (2007). STAMP: components of observable behaviour that indicate potential for patient violence in emergency departments. Journal of Advanced Nursing 59(1). Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/17543010.

National Institute for Occupational Safety and Health (2016). Violence Risk Assessment Tools. Retrieved from https://wwwn.cdc.gov/wpvhc/Course.aspx/Slide/Unit6_8

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