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1 Credit Quiz JAMA December 27, 2016

Ensuring Staff Safety When Treating Potentially Violent Patients

A man in his 40s with paranoid schizophrenia who had a history of incarcerations for various crimes, including assault, and had been recently released from prison, was admitted involuntarily to the inpatient psychiatric unit after setting a trash can on fire in a store. Because he had auditory hallucinations, the police brought him to the emergency department (ED) instead of jail. He was admitted to a psychiatric hospital and while there, he was discovered hiding in a female patient’s bathroom. Subsequently, he was placed on “aggression observation” status. Several days after admission, he tried to enter a female patient’s room and was diverted by staff back into his own room. He reemerged angrily a few minutes later and when another nurse attempted to calm him, the patient attacked the nurse by beating him in the head and stabbing him with a pen, causing severe injury. Because of the criminal aspects of this event, the police were called but would not take the patient into custody because his primary problem was psychosis.

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