Post Anesthesia Care Unit Comprehension Safety Program Quality Improvement Project on De-escalation of Patients

Background: Violence within the healthcare setting has risen significantly, and has crossed into areas where staff are less prepared to manage and deescalate challenging patient encounters. This lack of preparedness and confidence has led to increased staff stress, burn out, and can potentiate poor patient outcomes. Methods: A pre/post-simulation quality improvement project was performed within a tertiary hospital Post-Anesthesia Care Unit in Upstate New York to evaluate the effect of simulation on feelings of confidence and preparedness in patient de-escalation with PACU nurses and patient care technicians. The project evaluation included the Thackrey’s Clinician Confidence in Coping with Patient Aggression (CCPA) Instrument, De-Escalation Aggressive Behavior Scale (EDABS), and a project-specific simulation evaluation tool. Results: There was a statistically significant difference in the mean scores for the CCPA data pre and post across all questions. There was no correlation between length of being a RN (p < 0.498), length of working in the PACU (p < 0.492),or having any de-escalation training (p < 0.786), on the CCPA data. There was a statistically significant, moderate, positive correlation between age and ability to protect yourself physically from an aggressive patient, (r = 0.592, p < 0.026). There was no other correlation with age and other CCPA questions. Discussion: Simulation can be successfully used to train, develop, and improve staff confidence in patient de-escalation.