Decreasing Incidence of Intramuscular Emergency Psychiatry Medications in Psychiatric Adult Patients Through the Acute Violent Assessment Tool (AVAT)

Purpose The purpose of this QI project was to reduce emergency IM psychiatric medication usage by implementing the Acute Violent Assessment Tool (AVAT) to improve early aggression management. Background The frequent use of emergency intramuscular (IM) psychiatric medications in inpatient psychiatric settings raises concerns regarding patient safety, autonomy, and staff burden. This quality improvement (QI) project aimed to reduce emergency IM medication administration by 20% over three months by implementing the AVAT to improve early identification, prediction, and management of aggression and violence. Methodology A Plan-Do-Study-Act (PDSA) framework guided the AVAT implementation in an adult psychiatric unit. Three weeks of one-on-one AVAT training for nursing staff, followed by a three-month intervention and a week of data collection. Staff perceptions of safety were evaluated using the Essen Climate Evaluation Scheme (EssenCES©). Emergency IM medication rates were analyzed using incident reports from hospital risk management data. RESULT The AVAT compliance improved from 60% in the first month to 85% by the project’s conclusion. Emergency IM medication use decreased by 22%, surpassing the initial goal. Post-intervention Surveys revealed a 25% improvement in staff-reported perceptions of unit safety, as measured by the Essen CES©. Implications for Practice: The findings suggest that structured aggression assessment tools like AVAT can enhance early intervention, reducing the need for chemical restraint while improving staff confidence in managing aggression. Future efforts should focus on sustainability, refining AVAT integration into clinical workflows, and exploring long-term outcomes. This QI project demonstrates that proactive assessment and intervention strategies can foster a safer, therapeutic milieu in psychiatric care settings.