Apr 22 2013
The UK government operates a no tolerance policy to patient violence and antisocial behaviour in emergency departments, but staff are often reluctant to report incidents. This can cause significant disruption to the departments and stress for staff. One hospital trust in England has created a new role for a senior nurse to manage responses to such incidents. This has led to greater reporting of violence and enforcement of a warning system up to and including withdrawal of treatment for persistent offenders, within ethical guidelines.
A hospital emergency department has introduced a system of warnings to antisocial patients, which can lead to withdrawal of treatment. The scheme has reduced violence and led to fewer attendances by people known to be aggressive.
Despite a Department of Health 'zero tolerance' campaign against violence in emergency departments (EDs), Salford Royal NHS Foundation Trust (SRFT) found staff remained reluctant to report antisocial behaviour. So it introduced a new senior nurse co-ordinator role to manage such incidents.
Writing in the journal Emergency Nurse, two of ED staff explain that before the role was introduced the trust had sent only two warning letters, but that since the senior nurse co-ordinator took up post 86 initial warning letters, four final warning letters and three withdrawal of treatment letters have been sent.
They say much antisocial behaviour in the emergency department went almost unnoticed until the new role was established, but once a more thorough reporting system was in place it was discovered that a small number of people were responsible for many incidents.
The trust worked with Salford City Council and found these patients were creating similar problems in their communities and it adopted the council's system of requesting antisocial behaviour orders (ASBOs) for people responsible for six incidents within six months.
Commenting on the ethics of the new system, the authors say: 'Taking action against violent, aggressive or antisocial patients is a controversial subject and withdrawal of treatment is considered by some people to be unethical. The SRFT board considers that if such behaviour is not tolerated in the community, it should not be tolerated in emergency departments or waiting rooms, which are part of the community.'
They add that the warning system does not apply to patients whose behaviour may be due to mental illness or drug misuse.
'Withdrawal of treatment or requests for ASBOs are considered appropriate, therefore, for only a small number of people, for whom other interventions have failed. No ED should refuse to treat life-threatening conditions in patients, including those whose treatments have otherwise been withdrawn.'
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