How to Minimize Weapon Use in Hospitals

A position statement on weapons use in hospitals approved by APA’s Board of Trustees last month includes the recommendations below to reduce weapon use by staff in hospitals when dealing with behaviorally disturbed patients. “Weapons” include, but are not limited to, pepper spray, mace, nightsticks, Tasers, cattle prods, stun guns, and pistols.

Hospitals should minimize the unauthorized presence of weapons on their premises. As appropriate, these steps should include screening patients for weapons before admission to psychiatric emergency rooms and/or psychiatric inpatient units and screening patients assessed to be at high risk to others prior to admission to nonpsychiatric inpatient units.

Patients who pose a risk of harm to others should be managed by clinical staff using clinical approaches. These usual clinical approaches typically involve psychological interpersonal interventions and may include, when less-restrictive alternatives fail, the use of involuntary emergency medication, physical seclusion, and physical or mechanical restraint following guidelines issued by The Joint Commission and the Centers for Medicare and Medicaid Services.

Hospital clinical and security staff acting under the supervision of clinical staff should receive regular training in safely managing the risks posed by patients who present with agitation and are disruptive and engaging in escalating behavior.

Hospital administrations should ensure that clinical staffing levels are sufficient to facilitate proper clinical approaches to the management of patient violence risk that are sufficient to resolve the great majority of behavioral incidents.

Weapons should never be used by clinical staff or hospital security staff acting in a clinical capacity as a means of subduing a patient, placing a patient in restraint or seclusion, or otherwise managing violence risk.

Hospitals should have a policy in place to define when clinical control of a situation involving patient violence is being ceded to law enforcement or hospital security staff acting in a law enforcement capacity. ■