Implementing standardized aggression screening for residents in a rural long-term care facility: a quality initiative

Abstract

Background: There is a high prevalence of aggressive behavior in late life that has significant consequences for older adults, their caregivers, and healthcare professionals. Aggression in residents and patients in acute and long-term care facilities is dangerous for both the residents/patients and the staff. It is vital to detect aggressive crises early and intervene int order to reduce adverse health outcomes. The use of the evidence based Aggressive Behavioral Risk Assessment Tool-Long term care (ABRAT-L) upon admission to a long-term care facility may help staff recognize individuals head of time and plan for useful interventions to better help meet their needs. Local Problem: A rural long-term care facility in Montana elected to implement a standardized process for administering ABRAT-L assessments to their residents. Methods: The Iowa Model guided the implementation process over eight weeks. Intervention: Nursing staff administered an ABRAT-L assessment to eligible residents during their admission process. An ABRAT-L > or = 4 triggered the nursing staff to notify the physician and begin prescribed interventions. Data was collected and deidentified before entry into a spreadsheet for further analysis. Results: The project site had ten newly admitted residents that met the eligibility requirements for the ABRAT-L screening during the eight-week implementation period. Of the ten newly admitted residents, the charge nurse screened ten (100%) of identified eligible newly admitted residents. There were 13 residents who could have been screened during their quarterly assessments; however, screenings did not happen due to staffing/time constraints. Of the ten residents who completed an ABRAT-L, four screened positive for aggression risk with a score of four or greater. Conclusion: The findings supported the inclusion of the ABRAT-L's into assessments to aid in identifying resident aggression risk within a long-term care setting. Offering the ABRAT-L assessment improves the quality standards and allows early intervention for residents who may not otherwise receive treatment. The ABRAT-L assessment tool aims to enhance mental health care delivery and outcomes in a rural long-term care facility setting.