De-escalation includes three key areas; prevention and minimisation, planning and specific verbal de-escalation.

Prevention and minimisation

• Visible leadership with clear communication strategy for changes to care.
• Accessible education for patients and carers regarding COVID-19 safety precautions - hand hygiene, physical distancing, and the need for PPE.
• Information in patient areas (including in Easy Read format) - see COVID-19 (Coronavirus) resources.
• Adequate therapeutic intervention/diversional therapies/engaging in meaningful activity.
• Make use of TOP 5, wellness plans and safety pans for people with additional needs
• Access to belongings including telephones/smart phones/tablets especially for those in isolation and where visitor restrictions are in place.
• Increased opportunities for social connections (virtual family/friend/carer visits through virtual platforms).
• Virtual visits by care coordinators (case managers), NDIS supports, Community Managed Organisation support workers, psychologists etc.
• Physical activities i.e. virtual gym/exercise-based programs.
• Ensure collaborative care plan is up to date and advanced care directive is clear.
• Early assessment of nicotine dependence and proactive prescribing of Nicotine Replacement Therapy (NRT).
• Management of drug and alcohol withdrawal.
• For people identified as having a history of aggression, proactive medication management plans including PRN (as required) in line with local guidance.

Planning

• Risk assessment and patient led safety planning for patients with COVID-19 and risk of ASBD.
• Simulation training and mock training in de-escalation, restraint and PPE in patients that are COVID-19 positive.
• Staff to ensure duress alarms work under PPE.
• Environmental risk assessments with infection control unit advisor.
• PPE training for all staff.
• Regular practicing of donning/doffing PPE.
• For observation Level 1, skilled staff are used with regular relief opportunities (See also PD2017_025 - Engagement and observation in mental health inpatient units)
• Ensuring that PPE emergency packs are readily available for ASBD.
• Staff understand the environmental cleaning requirements.
• Refer to CEC - Respiratory protection program and .Education, training, posters and videos.

Verbal de-escalation

• The patient should be asked to wear a surgical mask.
• Where safe to do so staff should attempt verbal de-escalation from a Far Safe Zone (defined as beyond a punch and a kick) of a minimum 2 metres.
• Even though de-escalation is undertaken at a safe physical distance (beyond 2 metres) it is recommended that staff be prepared in full PPE (PPE as per COVID-19 risk assessment guide for direct care of patients).

De-escalation frequently takes the form of a verbal loop in which the clinician listens to the patient, finds a way to respond that agrees with or validates the patient’s position, and then states what they want the patient to do, eg, accept medication, sit down, etc.

This should include clear instruction as to infection control requirements and PPE e.g. “I understand that this may be scary. Staff are wearing masks and gloves to protect you and others from infection, please sit down”.

The loop repeats as the clinician listens again to the patient’s response. The clinician may have to repeat their message multiple times before it is heard by the patient.

Return to COVID‐19 Acute Severe Behavioural Disturbance Risk Formulation Framework.​​

Reference: Richmond J S et al. Verbal De-escalation of the Agitated Patient: Consensus Statement of the American Association for Emergency Psychiatry Project BETA De-escalation Workgroup​. Western Journal of Emergency Medicine. 2012;XIII(1):17-25. ​​