Prevention of patient violence should be initiated very early in the aggression process. In order to improve the early preventive interventions on a psychiatric intensive care unit (PICU), we introduced a training programme including the Bröset Violence Checklist (BVC) and structured preventive care plans.

We developed a standardized list of goals and interventions for patients at risk of becoming violent towards others, covering aspects of patient participation, information, support, general care, environment, observation and coordination. All members of staff were obliged to read the patients' care plans before entering the ward and carry out the interventions. The BVC estimates the patient's level of risk for violence during the next 24 hours. In the checklist six behaviour items are noted as present or not present; confusion, irritability, boisterousness, verbal threats, physical threats and attacks on objects. On the PICU, a nurse was assigned on each shift to assess the patients. If more than two items were present, interventions to prevent a violent incident had to be initiated.

The staff found the BVC easy to learn and use. An evaluation of the predictive capacity of the BVC on the PICU showed that the risk for violence in a short term perspective could to a high degree be predicted by the nursing staff. Similarly, we found that the standardized list for care plans was experienced as helpful and an often necessary tool, well suited to be combined with the BVC.