How to Ratchet Down Volatile Situations in the Urgent Care Center

Some 25% of nurses have reported being assaulted by a patient or a patient’s family member while on the job, according to a study published in the American Journal of Nursing. Risk is greatest in the emergency, geriatric, and psychiatric settings—all of which overlap with the urgent care patient population. Now The Joint Commission has issued a report that offers advice on de-escalating tense situations that could turn violent in a flash. Quick Safety, Issue 47: De-escalation in Health Care aims to help clinicians lower aggression and agitation in patients. It starts with recognizing subtle signs that a patient may be getting ready to go off, such as the “STAMP” set of behaviors (ie, staring, tone/volume of voice, anxiety, mumbling, and pacing); the Overt Aggression Scale; the Broset Violence Checklist; and the Brief Rating Scale of Aggression by Children and Adolescents. Some of the techniques for quelling a disturbance include creating a calm environment with softer lighting and minimal noise disturbance, if possible; deceptively simple diversionary tactics like asking the patient what kind of music they like; and treating the patient with respect and using a nonconfrontational tone and demeanor (in other words, poking the patient in the chest and screaming “Knock it off!” in his face is not the way to go). The entire report is available on The Joint Commission’s website.