Table 1.

Summary of Program Fidelity during the Nine-Month Post-Implementation Period.

Program Subcomponent	Program Director’s Comments from the Monthly Fidelity Assessments
1. Rounding in the lobby	Two hospitals did rounding consistently, one ED did not and identified that it was staffing dependent.
2. Screening all patients for early signs of potential escalation	A screening checklist was developed and initially planned to be used on all ED patients as a means to communicate potential risk to other employees. The checklist evolved to being used as needed to communicate early signs of potential escalation of violence. The majority of clinicians found it useful as a reminder to be alert to the early signs of escalation.
3. Concealed weapon assessment question during triage	One ED was consistent; clinicians routinely asked about the presence of weapons as part of the triage assessment. Several weapons had been turned over to security for proper storage at all three EDs. At one ED where there was inconsistency, some clinicians commented that they are uncomfortable asking about concealed weapons. At the other ED which was also inconsistent, some clinicians commented that they did not feel safe asking the question when they were alone with a patient in triage.
4. Flagging patients with a history of violence or exhibiting signs of potential violence	No EDs did this in any meaningful way. Reasons given was the size of the ED, one saying it was too big to communicate the levels, and one saying it was too small and that levels are communicated by word of mouth. The larger ED thought a tracker board visual to display the levels would be helpful.
5. Levels of awareness alerting employees of violent risk level in ED	Two sites initiated a system that worked consistently. Two of the hospitals found flagging to be very important. One ED flagged inconsistently.
6. Violent event response table	A table was developed with clear instructions as to what employees are to do in certain violent situations. The ED clinicians thought the table was helpful and used it in theory. Several ED clinicians did not have the response card on their identification badge as planned.
7. Care After Violent Event	Clinicians were consistently knowledgeable as to the procedures to take if they were a victim of workplace violence. This was particularly true if an injury occurred.
8. Reporting violence and debriefing	Clinicians were consistently knowledgeable as to the procedures for reporting a violent event. Clinicians reported that any debriefing that occurred was done informally with their manager.
9. Post incident reviews	One ED consistently posted reviews of violent incidents. One ED was inconsistent with their reviews while the last ED was not doing them.
10. Quarterly surveillance reports	One of the EDs was doing the reports and sharing with the clinicians. Two of the EDs were not consistently doing these.