Abstract
Introduction: Behaviours of concern (BOC) are actions that cause harm to patients or staff. Research focuses on BOC in emergency departments. Intensive care is a unique setting regarding staffing, acuity and interventions therefore BOC events may differ in an ICU.
Objectives: To describe the management of BOC in an adult ICU, identify variation in management between patient cohorts and establish compliance with unit policy.
Methods: A one-month, prospective, audit of an ICU was conducted to identify BOC. If an episode was identified, a questionnaire was completed. Additional data were taken from eMR. Data were described by management using chi-square and T tests.
Results: One-hundred forty-six BOC events were recorded during the study period. BOC were more common among male patients (74%) than female patients (26%). Most BOC patients were English speaking (99%) and 46% were ventilated. Management strategies were categorised as verbal reassurance, person-to-person restraint, mechanical restraint and chemical restraint, with the majority of patients managed by a combination of strategies (90%). Verbal reassurance (50%) and chemical restraint (48%) were the most commonly implemented strategies. Verbal reassurance was provided to 93% of events involving females and 77% of events involving males. Males were more likely to be managed with chemical or physical restraint than females. Patients with recorded substance abuse were more likely to receive verbal reassurance or chemical restraint than physical restraint. The Confusion Assessment Method for the ICU completion rates averaged 74%. Alcohol withdrawal screening (AWS) was underutilised, 16% of patients with a history of alcohol abuse had AWS recorded.
Conclusions: Male patients are more likely to be involved in a BOC event. BOC were commonly managed with a combination of strategies. Gender influenced the management strategy. Screening was under-utilised which may have contributed to initial and recurring BOC events.
Objectives: To describe the management of BOC in an adult ICU, identify variation in management between patient cohorts and establish compliance with unit policy.
Methods: A one-month, prospective, audit of an ICU was conducted to identify BOC. If an episode was identified, a questionnaire was completed. Additional data were taken from eMR. Data were described by management using chi-square and T tests.
Results: One-hundred forty-six BOC events were recorded during the study period. BOC were more common among male patients (74%) than female patients (26%). Most BOC patients were English speaking (99%) and 46% were ventilated. Management strategies were categorised as verbal reassurance, person-to-person restraint, mechanical restraint and chemical restraint, with the majority of patients managed by a combination of strategies (90%). Verbal reassurance (50%) and chemical restraint (48%) were the most commonly implemented strategies. Verbal reassurance was provided to 93% of events involving females and 77% of events involving males. Males were more likely to be managed with chemical or physical restraint than females. Patients with recorded substance abuse were more likely to receive verbal reassurance or chemical restraint than physical restraint. The Confusion Assessment Method for the ICU completion rates averaged 74%. Alcohol withdrawal screening (AWS) was underutilised, 16% of patients with a history of alcohol abuse had AWS recorded.
Conclusions: Male patients are more likely to be involved in a BOC event. BOC were commonly managed with a combination of strategies. Gender influenced the management strategy. Screening was under-utilised which may have contributed to initial and recurring BOC events.
| Original language | English |
|---|---|
| Pages (from-to) | S10 |
| Number of pages | 1 |
| Journal | Australian Critical Care |
| Volume | 35 |
| Issue number | Supplement 1 |
| DOIs | |
| Publication status | Published - Jan 2022 |
| Externally published | Yes |
| Event | ANZICS/ACCCN Intensive Care Annual Scientific Meeting 2022 - Sydney, Australia Duration: 27 Apr 2022 → 29 Apr 2022 https://www.australiancriticalcare.com/issue/S1036-7314(22)X0006-4 |
