Reducing high-risk interventions for managing aggression in psychiatric settings.

Seclusion and restraints have traditionally been major interventions for controlling patient aggression. The implementation of less restrictive measures may or may not be an option in managing individual cases of psychiatric emergencies. Improvement in patients, knowledge of alternatives and the need to reduce the use of restraints have led to the development of new tools to enhance prevention of high-risk interventions. At one institution, an anger management assessment tool and "Triangle of Choices" have assisted patients in identifying and managing feelings of frustration and anger. Since their inception 1 year ago, the implementation of documented alternatives to restraints has increased, and use of most restrictive measures has decreased.