Violent Patient Management: Advanced Safety, Security, and Clinical Support Strategies in Healthcare Settings
Abstract
Background: Workplace violence in healthcare settings is a prevalent and serious occupational hazard, disproportionately affecting frontline staff and disrupting clinical operations. Violent or aggressive patient behavior can stem from a complex interplay of medical, psychiatric, substance-related, and environmental factors, creating significant safety challenges for healthcare teams.
Aim: This review aims to outline advanced safety, security, and clinical support strategies for the management of violent patients, focusing on a systematic, interprofessional approach that prioritizes de-escalation, accurate diagnosis, and evidence-based intervention.
Methods: A comprehensive synthesis of current literature, guidelines (e.g., from ACEP), and best practices is presented. The review covers the epidemiology, etiology, and pathophysiology of violence, followed by a structured approach to evaluation, differential diagnosis, and a tiered management strategy ranging from non-pharmacological techniques to pharmacological sedation and physical restraint.
Results: Effective management begins with prevention through environmental design, staff training, and early recognition of agitation. The cornerstone of intervention is verbal de-escalation. When this fails and imminent danger exists, pharmacological agents (e.g., IM haloperidol/lorazepam, atypical antipsychotics, or ketamine) or physical restraints may be necessary, applied under strict protocols. A thorough medical and psychiatric evaluation is critical to identify and treat underlying causes. Complications of management include oversedation, respiratory depression, and physical injury.
Conclusion: Managing violent patients requires a balanced, patient-centered approach that integrates de-escalation, rapid stabilization, and definitive treatment of the underlying condition. Success depends on a coordinated interprofessional team, clear institutional policies, and a culture of safety that protects both patients and staff.
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Authors
Copyright (c) 2025 Haya Qasem Alanazie, Hussam Mohammed Ibrahim Althurwi, Saeed Mesfer Alghamdi, Khalid Mohammed Abdulrahman Alqarni, Nawaf Abdulhadi Alharbi, Khalid Ali Sahhari, Saeed Shaya Abdullah Al-Dossary, Suha Ali Ghazwani, Marwah Salma Alhazmi, Abdulrahman Yahya Ali Nukhayfi
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