Increasing the Rate of Documentation of Security Interventions in the Emergency Department Big Orange Security Sticker (BOSS) Project

Background: Security interventions in aggressive and violent patients in the emergency department (ED) are not always documented in the clinical record, which can compromise the effectiveness of communication, and increase clinical risks. Local Problem: Fewer than half of all security interventions are documented in the clinical record. Methods: The study had a pre- and posttest design including a retrospective audit of patient medical records and a staff survey. Intervention: A dedicated sticker, to be completed by nursing and security staff, was placed into the clinical notes as a record of the security intervention. Results: From 1 month before to 1 month after implementation, the rate of documentation of security interventions in clinical notes increased from 43.3% to 68.8% (P= .01), and was maintained for 3 months after implementation. Conclusions: The rate of documentation of ED security interventions in clinical notes can be increased by encouraging clinicians and security staff to collaborate and share documentation responsibilities.