Increased staff-to-patient ratio

Managing a patient with acute behavioural disturbance is a detailed flowchart for managing a patient with acute behavioural disturbance. Use the least restrictive intervention necessary to ensure the safety of the patient, staff and others.

In adults with acute behavioural disturbance, if verbal de-escalation and psychological intervention cannot be implemented, or do not elicit cooperation from the patient, consider increasing the staff-to-patient ratio. This involves utilising a quorum of staff, who visibly support the clinician negotiating with the patient. It may assist in gaining the patient’s cooperation with treatment (eg pharmacological management); however, if their distress or aggressive behaviour escalate and there is an imminent risk of significant harm, implementation of physical restraint to facilitate further urgent management may be necessary.

Increasing the staff-to-patient ratio may escalate the situation in children, older people and those with developmental disability; however, staff-to-patient ratios should be sufficient to allow safe and effective application of nonpharmacological management for acute behavioural disturbance. Staff-to-patient ratios should support a therapeutic and person-centred approach.