Document Type

Dissertation

Degree

Doctor of Nursing Practice

Major

Nursing

Date of Defense

7-16-2025

Graduate Advisor

Joshua Minks, PhD, NP-C

Committee

Kimberly Werner, PhD

Cheyanna Largent, MSN, APRN, PMHNP-BC

Abstract

Abstract Introduction: The purpose of this Quality Improvement project was to evaluate the implementation of the Behavioral Assessment and Response Team (BART) and evaluate its effect on occurrence and duration of violent restraints on non-psychiatric floors in a pediatric hospital. This QI project also aimed to correlate the use of the Broset Violence Checklist (BVC) to the utilization of the BART as a means of predicting patient escalation, as well as to assess the effect of booster education on the BVC and BART on bedside staff confidence in utilization of these resources.

Methods: Data was collected across three time periods: (1) pre-BART implementation, (2) post- BART implementation, and (3) post-booster education. A Poisson regression was completed to compare instances of violent restraint use, and duration of violent restraint use across the three data collection time periods. A paired sample t-test was used to compare bedside staff confidence levels pre- and post-booster education. Descriptive statistics were used to examine the utilization of BART and BVC scores.

Results: A Poisson regression revealed a statistically significant result of an 82% reduction in violent restraint incidents in the post-booster education time period as compared to the pre- BART time period (IRR = 0.18, 95% Cl [0.04, 0.53], p =.006). Following booster education, bedside staff confidence in utilizing the BVC significantly increased (t(251) = 4.65, p < .001). Statistical analysis of the data collected regarding the impact of the booster education on utilization of the BART, and the impact of BVC scores on utilization of the BART, did not yield significant results, this was potentially due to small sample size and inconsistent fidelity to use of the BVC by bedside staff.

Implications for Practice: The findings of this QI project suggest that the BART and targeted booster education are useful tools in reducing violent restraint use in pediatric behavioral health populations. Utilization of the BART, continued education and training, and use of the BVC to predict patient escalation will be continued to mitigate violent restraint use.

Download

Share

COinS