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Violence Assessment Tool

This document contains an assault and violence assessment tool used to evaluate patients. It assesses key risk factors such as history of violence, substance abuse, paranoia, and impulsivity. For each factor, the patient is given a score of 0, 1, or 2 points depending on the level of risk. A total score of 9 or more indicates high risk precautions, 3 to 8 points indicates moderate risk precautions, and 0 to 2 points indicates no precautions are needed. The tool is used to help determine the appropriate level of precautions for each patient.

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mahmoud
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598 views1 page

Violence Assessment Tool

This document contains an assault and violence assessment tool used to evaluate patients. It assesses key risk factors such as history of violence, substance abuse, paranoia, and impulsivity. For each factor, the patient is given a score of 0, 1, or 2 points depending on the level of risk. A total score of 9 or more indicates high risk precautions, 3 to 8 points indicates moderate risk precautions, and 0 to 2 points indicates no precautions are needed. The tool is used to help determine the appropriate level of precautions for each patient.

Uploaded by

mahmoud
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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PATIENT IDENTIFICATION

ASSAULT AND VIOLENCE ASSESSMENT TOOL


DIRECTIONS: (a) Assess each key factor; (b) Circle one [of three] descriptors for each factor best describing patient; and (c) Add circled items to sum total score.

Key Factors High Risk - 2 POINTS Moderate Risk - 1 POINT No Precautions - 0 POINTS
Any single episode of violence with Destruction of property without injury Violence only when using drugs or
HISTORY injury to others while hospitalized -OR- to others while hospitalized -OR- A alcohol -OR- Destruction of property
OF Multiple assaults with injury while single assault outside the hospital outside the hospital -OR- No history of
VIOLENCE outside hospital resulting in injury -OR- Multiple assaults violence.

2 outside the hospital not resulting in injury. 1 0


HISTORY OF Physically threatening Verbally threatening Nonthreatening
RECENT at time of at time of at time of
AGGRESSION referral/admission 2 referral/admission 1 referral/admission 0
HISTORY OF Victim or perpetrator Witness Witness or victim of verbal aggression
AGGRESSION IN of physical of physical -OR-
FAMILY OR ORIGIN or sexual abuse 2 or sexual abuse 1 No history of aggression in family 0
Rehabilitated abuser -OR- No history
SUBSTANCE Recent alcohol/substance abuse Recent substance/alcohol abuse of alcohol/substance abuse -OR- Past
ABUSE activity detoxing -OR- Currently under with absence of withdrawal history (>3 months ago)
STATUS the influence of alcohol or drugs symptoms alcohol/substance abuse with no

2 1 rehabilitation 0
Paranoia or hostility generalized Paranoia or hostility generalized No apparent paranoia
PARANOIA /
to people in the immediate toward inaccessible people No apparent hostility
HOSTILITY
environment 2 Verbally impulsive
1 0
IMPULSITIVITY Physically impulsive -OR- No apparent impulsivity

Psychomotor agitation with


2 History of physical impulsivity
Psychomotor agitation with
1 0
AGITATION constant pressured intermittent bursts of No apparent psychomotor
physical activity 2 hyperactivity 1 agitation 0
SENSORIUM Disoriented with impaired memory Oriented with impaired memory Oriented with intact memory

2 1 0
TOTAL SCORE 9 or more = High-risk precautions 3 to 8 = Moderate-risk precautions 0 to 2 = No precautions

Total Score: ___________ Assessed by (RN): ____________________________________ Date: ___________ Time: ___________
ASSAULT and VIOLENCE ASSESSMENT TOOL (Courtesy of Psychiatric Nursing, Institute of Psychiatry, Medical University of South Carolina).

8850064 Rev. 09/04 Assault & Violence Assessment Tool_PSYCHIATRY PAGE 1 of 1

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