Bed Side Risk Assessments, Part 2

As we continue the discussion on bed side risk assessments, I want to bring your attention to the Bröset Violence Checklist (BVC). Like the STAMP tool we discussed in Part 1, the BVC is an observable behavior assessment based on six behaviors: confusion, irritability, boisterousness, verbal threats, physical threats, and attacks on objects. The focus of the BVC is to predict the likelihood of an attack within the next 24 hours. It has a stated short term relevance in the care of the patient.

The goal of this assessment, like many of its counterparts, is to make the assessment of violence risk a regular and ongoing part of patient care. The desired process is to evaluate at regular intervals the observable behaviors listed in the tool. Let’s take a moment to break down those behaviors and identify the kind of questions a bedside nurse might ask themselves when completing this assessment:

Confused: Does the patient appear confused or altered?

Irritable: Is the patient easily angered?

Boisterous: Is the patient loud or prone to disruptive behavior?

Physically Threatening: Is the patient’s posture threatening? Are they making fists or trying to block you in the room?

Verbally threatening: What are they saying, and are their words directly or indirectly threating? Are they yelling directly at you and being verbally abusive?

Attacking Objects: Is the patient throwing items around the room, or are they punching the wall?

The simplicity of observable behavior based tools like the STAMP tool and the BVC helps to increase the level of inter-rater reliability as well as lower barriers for implementation due to the ease of training for use. Of interest, the creator of the BVC claims that staff can be trained in as few as 10 minutes.

The BVC is designed to increase the risk level based on the accumulation of the identified behaviors. Each behavior is rated with a 0, if not present, or a 1, if present. Any cumulative score of 2 or more indicates a high risk of active violence within the next 24 hours, and this warrants proactive planning.

The BVC is one of the most well researched violence risk assessment tools out there. It was developed in 1995 in Norway, and has been in use since. A 2008 study demonstrated a 41% reduction in violence incidents, a 2011 study demonstrated a 68% reduction, and a 2015 study demonstrated a 48% reduction in violent events. The immense body of research surrounding the BVC and the incredible reduction in violence associated with the tool’s regular and ongoing use helps to make it stand out among its peers in the field of bed-side risk assessment.

What are your thoughts? Would the implementation of a tool like the BVC be beneficial at your facility? I look forward to hearing from you, and to continuing the conversation.

For more information on the BVC, check out this link to a presentation from the BVC creator Dr. Roger Almvik, Research Director, St Olav’s University/Norwegian University of Science & Technology. Click Here

Also – There is an app for that. The BVC has it’s own app. Check it out on Apple and Andriod Devices.


Almvik, R. (2015). Risk assessment made easy The Bröset Violence Checklist (BVC). Retrieved from

Woods, P., & Almvik, R. (2002). The Bröset violence checklist (BVC). Acta Psychiatrica Scandinavica Supplemetum(412). pp 103-105.

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