Joint Commission Reviews De-escalation Techniques

PUBLISHED: Jan 30, 2019
Relevant to: All Healthcare Organizations

The Joint Commission Quick Safety Issue #47 addresses de-escalation in health care settings and presents different de-escalation models and interventions for managing violent/potentially violent and/or aggressive/potentially aggressive individuals in the ED and inpatient settings. De-escalation is considered a first step response to violent/aggressive behavior.

According to TJC, there is not a lot of research that verifies the efficacy of de-escalation, and currently there is not a “gold standard” for practice. That said, studies do identify the following positive outcomes from the use of de-escalation techniques:

  • Preventing violent behavior
  • Avoiding the use of restraints
  • Reducing patient anger and frustration
  • Maintaining the safety of staff and patients
  • Improving staff-patient connections
  • Enabling patients to manage their own emotions and to regain personal control
  • Helping patients to develop feelings of hope, security and self-acceptance

TJC defines de-escalation as “…a combination of strategies, techniques, and methods intended to reduce a patient’s agitation and aggression. These can include communication, self-regulation, assessment, actions, and safety maintenance in order to reduce the risk of harm to patients and caregivers as well as the use of restraints or seclusion.”

The Quick Safety Issue presents three formal cyclical de-escalation models from the literature and also suggest the following techniques for diffusing aggression:

  • "Utilize verbal communication techniques that are clear and calm. Staff attitudes must be non-confrontational in use of verbiage. Avoid using abbreviations or health care terms.
  • Use non-threatening body language when approaching the patient.
  • Approach the patient with respect, being supportive of their issues and problems.
  • Use risk assessment tools for early detection and intervention.
  • Staff attitudes, knowledge and skill in using de-escalation techniques must be practiced and discussed in an educational format.
  • Respond to the patient’s expressed problems or conditions. This will help create a sense of trust with the health care professional.
  • Set clear limits for patients to follow.
  • Implement environmental controls, such as minimizing lighting, noise and loud conversations.”

Quick Safety #42 also presents strategies from inpatient behavioral health units and interventions from the Safewards Model. Follow the link below for additional information.

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