Combative-Destructive Precautions

Date of Last Review: 5/13/2011
SME: Chief Nurse Officer

All patients have the right to be protected from physical and emotional harm.  Close observation of agitated, violent or potentially violent patients is necessary to preserve this right.

Criteria for combative and/or destructive precautions are as follows, but not limited to:

1.                  Patient is visibly agitated (i.e., pacing, clenching fists)

2.                  Pressured and/or loud speech, argumentative behavior

3.                  Threatening others, hostile

4.                  Slamming doors, kicking, throwing or hitting objects

5.                  History of violence and impulsivity

Procedure:

An order for precautions is entered by the physician. A registered nurse may also initiate the precaution (as an independent nursing intervention), and the physician will be notified of the patient's condition.  A physician's order must be obtained within 24 hours of the nursing order.The order must include the precaution reason. 

Documentation of the specific behavior necessitating precautions is made in the progress notes.  Thereafter, the RN will document an assessment every shift on the Nursing Flow Sheet/Progress Notes.  The patient is advised when precautions are being implemented and discontinued.

Combative/Destructive Precautions require judgment on the part of the caregivers and should include:

1.                  Assessments of patient behavior and whereabouts.

2.                  Documentation of the assessments every 15 minutes on the Precautions Checklist.

All precaution orders are reviewed daily by the physician and treatment team for continuation.

Care guidelines for patients on CD Precautions:

1.      Unit Restrictions

2.      Observe level of agitation every 15 minutes. 

3.      Offer medication as needed (PO PRN).

4.     Utilize 1:1 staff talk to establish rapport with the patient.

5.     Provide adequate personal space for agitated, aggressive, or potentially violent patients.

6.      When possible, assign patient to private room.

7.      Utilize Direct Observation, as indicated.

8.      Educate patient about positive Coping Skills.

9.      Recommend Anger Management Group

10. Include all interventions in the MTP.

Related Standards:

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