Abstract
Background: Aggressive behavior and incidents in psychiatric wards are commonplace and management approaches should be evidence based. This audit aims to review the management of violent incidents and aggressive behaviour in the acute wards of the Federal Neuropsychiatric Hospital Calabar against the NICE Guidelines on Violence and Aggression(2015).
Methods: All documented outburst of aggression in the acute wards during a 50 day period were reviewed against a checklist
developed with reference to the NICE Guidelines on Violence and Aggression (2015) with the following items: evidence of use of deescalation, evidence of use of an emergency code or alarm, use of a protocol for restrictive interventions ( m a n u a l r e s t r a i n t , r a p i d
tranquillization, seclusion) and the use of an incident reporting format.
Results: Seventy five people were admitted in the acute psychiatric wards during this period, and there were 25 recorded incidents of aggressive behavior and violence. Verbal aggression was documented in 8% (n=2) of cases reviewed, physical and verbal aggression was documented in 84% (n=21) of cases reviewed and suicidality accounted for 8% (n=2) of cases reviewed. There was documentation of some form of de-escalation in 40% (n=10) of the cases reviewed but the majority of 60% (n=15) did not document de-escalation as an aggression management technique. There was neither a standardized incident reporting format nor properly documented protocol for restrictive interventions, including rapid tranquilization. Observation was under reported.
Conclusion: The prevalence of violent incidents at this facility correlates with findings from other facilities but there is no clear approach to aggression and violent incident management. It appears clinical staff use their best judgment. The facility would improve patient and staff safety by implementing a range of strategies including the development of locally relevant guidelines to effectively manage violence and aggression in Psychiatric units and Hospitals. Although the study sample is small and convenience-based, the dearth of research on this issue justifies this research and makes it applicable a c r o s s m u l t i p l e r e s o u r c e - constrained contexts.

Key words: K e y w o r d s : A g g r e s s i o n , P s y c h i a t r y , M a n a g e m e n t , Calabar.