Feasibility of Using Dynamic Appraisal of Situational Aggression to Reduce Agitation in an Inpatient Psychiatric Unit

Agitation in inpatient psychiatric units is common and is an important area for research given its impact on staff and patients. This study explores the feasibility and utility of the Dynamic Appraisal of Situational Aggression (DASA) risk assessment instrument. The quality improvement project was implemented on two acute care inpatient psychiatric units in upstate New York (NY) over a two-and-a-half-month period. The study investigated the association of DASA scores with interventions. The interventions included emergent medication for agitation, seclusion, or restraint as measures of agitation. The study compared DASA scoring related to agitation levels in patients with the occurrence of administration of emergent medication, seclusion, or restraints for the same patients. This was done to investigate whether a higher DASA score correlated with more interventions. A two-sample t test was used to explore the link between DASA scores and interventions, including emergent medication, seclusion, and restraint. The study also investigated mental health nursing perspectives of the scoring tool through descriptive analysis. An anonymous survey was administered to nurses with five questions designed to assess how easy the scoring tool was to use and their perception of its utility. Analysis showed no association between the DASA score and interventions for agitation. The feasibility of the DASA tool was achieved, as survey results showed that nurses found DASA user-friendly. Potential reasons for these results could be associated with multiple factors, including the nature of agitation on these inpatient units and barriers to compliance with the tool.