Authors (including presenting author) :
Tse CY(1), Chen MY(1), Cheung CM(1), Mak KH(1), Tse WH(1), Suen HN(1), Hon CH(1), Cheng MT(1), Lau I(1), Lam KL(1), Ip PYM(1), Ho KH(1), Mak LTB(1)
Affiliation :
(1) Department of Psychiatry, Tai Po Hospital
Introduction :
Using advanced safety planning is a global trend that effectively addresses emotional distress and aggressive behavior with psychiatric diagnoses. It is essential for supporting patients’ self-regulation of aggression and ensuring workplace violence related staff safety, which identified in the risk registry of Tai Po Hospital from 2023 to 2025. To address the patient needs, a structural intervention - the Emotional Comfort Plan (EC Plan) was introduced in psychiatric wards at Tai Po Hospital since 08/2024. Based on advanced safety planning, it emphasizes recovery through individualized and self-directed approaches, empowering patients to manage their emotions during aggression or distress with personalized de-escalation strategies.
Objectives :
1. Enhance patients’ self-regulation of aggression 2. Enhance nurses' competence in managing patients' emotional outbursts 3. Reduce staff IOD resulting from workplace violence
Methodology :
Patients with aggressive tendency required with close observation or medium/high level of violence risks at Dynamic Appraisal of Situational Aggression Assessment are targeted for implementation of EC Plan. Based on the RNAO Best Practice Guidelines, it provides guidance for identifying personal triggers, recognizing warning signs of escalating emotions, and exploring individualized self-regulating strategies through patient collaboration and safety contracts. A De-escalation Reminder Notecard is used to record for patient’s self-help mode. The plan highlights the importance of debriefing with patients and ensuring effective handovers among ward staff. Over a 4-month period, the evaluation will monitor the number of participated patients, the number of staff attending training, satisfaction levels of patients and staff, and incidents of workplace violence-related IOD in 2024.
Result & Outcome :
From August to December 2024, total 62 patients, who 87% of them (n=54; N=62) reported an improvement in self-regulation of aggression, were implemented with EC Plan. 92% of them (n=57; N=62) were confident in using De-escalation Reminder Notecard after being discharged to the community. In satisfaction survey.
56% of inpatient nursing staff (n=112; N=199) participated in three training sessions for EC Plan. The rest of staff were received training through ward representatives. Staff satisfaction survey conducted in 11 psychiatric wards, which all wards agreed EC Plan could serve as an advanced safety measure during the de-escalation process, thereby enhancing their awareness of de-escalation techniques, and fostering mutual understanding and rapport between patients and staff.
Regarding IOD incidents in 2024, a comparison between March to July and August to December shows a significant reduction from 9 cases to 6 cases after the implementation of the EC Plan, highlighting its effectiveness.
