RISK MANAGEMENT: DE-ESCALATION/ESCALATION DEFENSIVE

AT EVERY PHASE: #1 = Empathic Listening (MOST IMPORTANT TOOL) Offer re-assurance/reality orientation Assist with recalling/identifying crisis prevention tools/activities Assist with use of tools/activities Add helpful strategies to the patients plan

CRISIS PHASE

BEHAVIORAL CUES

INTERVENTION SUGGESTIONS

DEFENSIVE Crisis intervention Supportive/DIRECTIVE containment Supportive limit setting Assist with use of tools/destim. Sensory room? Own room? Silent Code

Physical Cues:

Physical Emotions Actions

Glaring/Decreased blinking Clenched jaw/teeth Flushed Restless/Shaking Muscle tension Sweating Nausea Headache Tremulous Shallow breathing vitals c/o heart pounding Angry Fearful Negativism Crying Withdrawn Panicky Sad Irritable Pacing Challenging/Threatening Belligerent/Demanding Swearing Slam door Refuse treatment Intrusive Hoarding Throw self on floor Attempting to elope

Emotional Cues:

Actions:

Talk with staff/Assist with problem solving Directive limit setting Remove audience Offer PRNs Give space Take a time out/decrease environmental stim Weighted blanket Deep breathing Use of rocking chair/glider Journal Music (if safe) Hot shower/bath Aromatherapy Distraction techniques Self-soothing techniques Exercise Silent code

EXAMPLE: Problem identified: Anxiety Calm

______________________________________________ 0 1 2 3 4 5 6 7 8 9 10

Crisis

Calm/relaxed pre-anxiety anxious/frustrated defensive Feel good Body feels tense Muscle aches Headache Peaceful Pre-occupied Ruminating thoughts Angry thoughts

Outbursts Yell or cry

------------------ Increased loss of self-control

Champagne, 2006