The BVC and SOAS-R; The perfect duo to make organisations safer

General 14 october 2020  - Roel Ruiken

The BVC (Bröset Violence Checklist) and the SOAS-R (Staff Observation Aggression Scale ̶ Revised) are the ideal complementary duo that help to make (mental health care) organisations safer. The BVC signals early signs of irritability and agitation of patients before they can grow into full blown violent incidents. In cases that violent incidents nevertheless do occur, the SOAS-R helps to document and evaluate why things got out of control anyway, thus informing future prevention. Using both instruments together provides the ideal feedback loop to ward teams to maximize their grip on, and understanding of, inpatient aggression. How this complementary interaction of these two instruments works underneath will be explained in more detail in the following.

The BVC, continuously keeps ward teams vigilant for warning signs of imminent aggression. By helping the team trace day to day changes of warnings signs of each of the patients on the ward, the BVC is key in reducing the number of occasions in which mild irritability and agitation of patients can turn into full blown violent incidents. A large number of studies have demonstrated that routine use of the BVC on psychiatric wards is accompanied by a reduction of severe incidents of aggression. For an oversight of empirical BVC studies, please consult this webpage:, which is part of the BVC-website called A large body of evidence, including several RCT’s, leaves no doubt that increased BVC scores of patients indeed go along with increased risks of violent behaviour in the next 24 hours. This gives ward teams and psychiatrists more time and options to prevent incidents, and for this reason the NICE guidelines recommend the use of the BVC.

When things nevertheless do go wrong, its partner instrument, the SOAS-R, comes into play. In cases of violent incidents, the SOAS-R helps to analyse and evaluate what went wrong in a very time-efficient and standardized way. The SOAS-R invites caregivers to reflect on many important questions that have to be posed in the aftermath of violent episodes. Why did things get out of control? At what time, location, and for what reason did the patient engage in violent or destructive behaviour? Against whom (or what) was the violent behaviour directed? How did the ward team respond and manage the violent behaviour? What were the consequences of the behaviour etc. In other words, completing the SOAS-R gives caregivers more detailed information about incidents that still occur on a ward, even though the BVC is in use. In that way, the combination of the BVC and the SOAS-R together form a constant feedback loop that will help teams sharpen and grow their preventative skills, which leads to increasing safety in mental health facilities.

In sum, the BVC constantly keeps the focus on potential aggression risks, while the SOAS-R helps to learn from incidents that nevertheless occurred. Together the complimentary use of BVC and SOAS-R yield a synergistic effect and make ward teams more resilient against the constant threat that aggressive patients poses for fellow-patients and mental health professionals and thereby making organisations safer.

General 14 october 2020  - Roel Ruiken
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