Disruptive behaviors in inpatient settings, including verbal aggression, repeated limit-testing and escalating agitation, can pose significant safety risks for patients, staff and visitors.
Although the medical center has established processes for addressing violent behavior through BART activation and Safety Alerts, nursing leadership identified a critical gap — early disruptive behaviors were not consistently documented in Epic. Minor but repeated incidents often lacked structured reporting, which limited clinicians’ ability to recognize patterns and intervene proactively.
Documentation Challenges
A review of reported documentation from July 2023 through July 2024 revealed that essential details — minor behavioral episodes, staff interventions and patient responses — were frequently missing or inconsistently recorded. This variability made it challenging to identify behavioral trends, ensure continuity of care and facilitate effective communication among interdisciplinary teams.
Standardizing Documentation: The Disruptive Behavior Progress Note Smart Text
In 2024, the surgical and neuroscience immediate care unit nursing teams, nurse psychiatric liaisons, risk management, Epic analysts and unit leadership worked together to design a standardized documentation tool: the Disruptive Behavior Progress Note SmartText. Built within Epic SmartLists, this tool guides nurses through objective, behavior-focused charting by prompting them to select descriptive behaviors, document staff interventions and record patient responses. By standardizing these elements, SmartText improves early recognition of behavioral patterns, enhances communication across shifts and supports informed clinical decision-making.
Pilot Program: Successful Implementation and Feedback
A pilot program launched in early 2025 demonstrated strong adoption. The tool was used 23 times by 16 clinical team members across the surgical immediate care and neurosciences units and 100 percent of staff reported that it would be helpful if implemented hospital wide. Nurses praised the structure and clarity the SmartText provided. Feedback from the pilot informed refinements, including improved editability and optimized dropdown menu options.
Hospital-Wide Safety Strategy
On February 18, 2025, the Disruptive Behavior SmartText went live across all inpatient units. What began as a unit-level initiative evolved into a hospital-wide safety strategy, showcasing the power of frontline innovation and collaborative design. This standardized approach supports early recognition, enhances communication across teams and prioritizes the safety of patients, staff and visitors.
The Disruptive Behavior SmartText now serves as an important tool in strengthening behavioral health awareness and empowering frontline nurses to manage complex behavioral situations effectively.