This document is a summarised version of DG-GC6-Pharmacological Management of Acute Behavioural Disturbance in the Emergency Department, DP-EP4-Prevention and Management of Patients with Behaviours of Concern in the Emergency Department . The summary has been created to be Emergency Department specific, and has been endorsed by the ED Leadership Team. Staff should review this document if they require further information.
The safety of staff and patients is paramount in the Emergency Department. Patients with behavioural disturbance pose risks of occupational violence and aggression (OVA) to themselves and others, including staff, other patients and visitors.
This QRG applies to all presentations to the Emergency Department of patients displaying Behaviours of Concern.
It is the responsibility of the Nurse Unit Managers and Directors of the Emergency Departments of each site to ensure the relevant staff are familiar with this QRG and associated PPGs.
Prediction of “Behaviours of Concern” (BOC) and prevention of escalation through awareness of the following key concepts are critical to risk reduction such as risk/hazard identification, risk assessment and control measures to reduce/minimise the risk.
All patients should have a risk assessment performed using the BOC Chart at the same time as other vital signs.
Figure 1: ED BOC management matrix |
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BOC of 1 or more should be escalated to the NIC and Senior Medical Officer.
All patients should be assessed for organic causes of behavioural disturbance.
The Management Matrix collocated with the “BOC Chart” should guide all management
Non-pharmacological management:
Pharmacological management
According to the Pharmacological Management of Acute Behavioural Disturbance in the Emergency Department Guideline (Emergency Department DG-GC6)
Behaviour Assessment Unit (BAU; SHED specific)
The operational and functional purpose of BAU is to manage and assist patients that present at high risk of self-harm or causing harm to others, including highly agitated and/or aggressive patients.
The BAU provides a dedicated space within which a multidisciplinary team can work. The environment is designed to be low stimuli and have increased privacy, improving the patient experience.
BAU will operate 24/7, 365 days. It will be staffed with nursing, medical and mental health clinicians.
Behaviour Assessment Room (BAR)
The purpose of using the BAR is to provide a safe environment to manage behaviours of concern in a location which maintains privacy for the patient, and limits distress for other patients and relatives. There are two BARs that form part of the overall BAU with nursing and medical support.
The decision to utilise the BAR is made by the Senior Medical Officer, in collaboration with the Nurse in Charge and Team Leader of Resus/BAU of the shift and where appropriate, in consultation with specialist services (e.g. Mental Health clinicians and security).
This decision will be based on the risk of violence, considering the following:
The use of this space is outlined in more detail in DP-EP4 Prevention and Management of Behaviours of Concern in the Emergency Department (Including use of Behavioural Assessment Rooms)
Security responses
Security are in attendance in ED 24 hours a day and should be proactively engaged through:
Applies the same principles with additional consideration to:
| Title: | BOC Management in Western Health Emergency Departments | |
| Version: | 2.0 | |
| Date Published: | June, 2022 | |
| Date of scheduled review: | March 2024 | |
| Author: ED Leadership Team | Approver: ED Leadership Team | |
| Edited by: Ian Law | Date: 15 March 2023 | |
