Introduction to the Broset Violence Checklist
The Broset Violence Checklist is a simple, six item list that was developed to predict violent behavior in psychiatric patients before it escalated into a dangerous episode of resident violence. Use of this checklist was found to be useful in identifying patients who were beginning to decompensate and allowing staff to implement appropriate measures to prevent violent attacks. It’s use in nursing homes has not been routinely reported but might provide a useful tool to help prevent resident-on-resident or resident-on-staff violence.
Background on Nursing Home Resident Violence
Increasing episodes of violent behavior by nursing home residents against staff or other residents have been reported. Consequently, working as a nursing assistant has been found to be more dangerous than working as a coal miner. The internet has an abundance of plaintiff attorney sites highlighting the problem and offering their legal remedies for the resident violence situation. Reasons for the increase in nursing home resident violence include:
- more robust reporting of incidents due to heightened awareness and federal regulations,
- an influx of sicker, more behaviorally disturbed dementia residents into nursing home care,
- the admission of greater numbers of severely ill psychiatric patients into the long term care setting due to closure of psychiatric hospitals and clinics
Decreasing funding for nursing home care, increasing care expectations from regulators and the public, and the totally delusional belief that resident needs are better met by expanding the number of staff involved in paperwork and decreasing the number of actual care-givers contribute to the problem as well.
Predicting Resident Violence with the Broset Violence Checklist
The Broset Violence Checklist is used to predict the likelihood of violent behavior within the next twenty-four hours. The six-item resident violence behavioral checklist includes:
- physical threats
- verbal threats
- attacks on objects
Scoring the Broset Violence Checklist
Each item in the checklist is either present (1) or absent (0) in the scoring system and the scoring is done against the patient’s normal baseline behavior. Scoring is: 0 - Small risk of violence 1-2 Moderate risk of violence 3 or greater Very high risk of violence For high risk residents preventive measures are required and plans for handling or preventing an attack should be activated immediately.
Potential Use of the Broset Violence Checklist in a Nursing Facility to Prevent Resident Violence
Prior to, or upon admission to a nursing facility, an assessment of the resident’s prior behavior should be obtained. A history of violence should lead to development of plans to identify and interventions to prevent resident violence. Residents with a history of violence need frequent monitoring to establish knowledge of their baseline behavior and clues to impending aggressive episodes. Use of the Broset Violence Checklist at regular intervals might provide an earlier, objective warning to staff that a resident is starting to escalate. Behavioral or medical interventions should then be implemented such as removing the resident form common resident areas, using two persons for personal care, and possibly, initiating or increasing psychotropic medication to calm the resident.
The Broset Violence Checklist might be a useful tool in preventing resident violence in nursing facilities. By anticipating the likelihood of violence within the next twenty-four hour period, interventions could be implemented before, rather than after, violence occurs. Though it has not been formally studied in the long term care setting its utility in predicting violence in psychiatric institution patients indicates its potential utility in nursing home residents, many of whom have severe psychiatric illness.