A survey of assaultive behavior in veterans health administration facilities

Objective: To more clearly define the scope and impact of violence in healt h care facilities, national data on assaults in VA medical centers and free standing clinics were examined. Methods: A survey was distributed to all VA medical centers and freestanding clinics asking for cumulative data for on e fiscal year (October 1990 through September 1991). Data were obtained on number, types, and locations of physical assaults and other assaultive beha vior; the types of staff assaulted and number of workdays lost due to injur ies; diagnoses of perpetrators; recommendations made after the incidents we re reviewed; training in prevention and management of assaultive behavior; and the impact of training on rates of assaultive behavior. Results: During the survey year, 24,219 incidents of assaultive behavior were reported by 166 VA facilities; 8,552 incidents involved battery or physical assault. We apon possession by perpetrators was common (8.5 percent of incidents), and weapons were used in 130 assaults (1.5 percent of assaults). Assaults occur red most frequently in psychiatric units (43.1 percent), followed by long-t erm-care units (18.5 percent) and admitting or triage areas (13.4 percent). Assault-related injuries were most common among nursing personnel. Perpetr ators of assaults were most typically diagnosed as having psychoses, substa nce use disorders, or dementia. On inpatient psychiatry units, an inverse c orrelation was found between expenditures on staffing and the frequency of assaultive incidents. Staff training on management of assaultive behavior v aried widely. Conclusions: Assaultive behavior is a significant problem for health care workers. Staff in all clinical areas need to be prepared to de al with assaultive patients. More research is needed on staff training and interventions for preventing and limiting assaults.