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Mock Drills for Abuse Situations

A resident-to-resident incident occurred on the dementia unit, resulting in an injury to one resident. The altercation surprised the staff, so their response to the situation was not immediate. Additionally, when they intervened, they did not de-escalate the situation well. Does this sound familiar? When an abuse situation occurs, it is imperative that staff know how to respond and that the response occurs promptly to ensure resident safety. It is the director of nursing services’ (DNS’s) responsibility to provide opportunities for the staff to practice and perfect their responses to these events. Mock drills are useful tools that help to improve quality of care and safety for residents through practice. This article will discuss a framework the DNS can use to develop mock drills to help prepare staff for resident-to-resident and visitor- or staff-to-resident abuse situations.

Federal Requirements

A mock drill framework should be based on regulatory requirements to ensure it achieves desired outcomes and maintains regulatory compliance. F607 in Appendix PP of the State Operations Manual states that facilities must have training for new and existing staff and in-service training for nurse aides on the following topics:

  • Prohibiting and preventing all forms of abuse, neglect, misappropriation of resident property, and exploitation;
  • Identifying what constitutes abuse, neglect, exploitation, and misappropriation of resident property;
  • Recognizing signs of abuse, neglect, exploitation and misappropriation of resident property, such as physical or psychosocial indicators;
  • Reporting abuse, neglect, exploitation, and misappropriation of resident property, including injuries of unknown sources, and to whom and when staff and others must report their knowledge related to any alleged violation without fear of reprisal; and
  • Understanding behavioral symptoms of residents that may increase the risk of abuse and neglect and how to respond. These symptoms, include, but are not limited to, the following:
    • Aggressive and/or catastrophic reactions of residents;
    • Wandering or elopement-type behaviors;
    • Resistance to care;
    • Outbursts or yelling out; and
    • Difficulty in adjusting to new routines or staff. (CMS, 2023)

Furthermore, the facility must have a process in place for reporting allegations of abuse. Mock abuse drills can be a powerful tool in the DNS’s training toolbox to maintain compliance with F607 and ensure resident safety.

Why Conducting Mock Abuse Drills is Important

Facilities often utilize mock drills to practice for fire or elopement situations. However, the DNS can also apply the mock drill procedure for other situations, such as abuse, to ensure staff know what to do to maintain resident safety. Mock drills not only allow staff to practice their roles but also enable the DNS to evaluate staff competency in abuse situations, recognizing strengths and identifying areas that need improvement. Mock drills also provide opportunities to:

  • Sharpen staff members’ skills in a non-threatening learning environment
  • Clarify the roles of team members and ancillary staff during an abuse situation
  • Establish a plan to maintain order (Nursing2004).

Prepare and Conduct a Mock Drill

Conducting a good mock drill takes preparation. Drills should be planned in advance and conducted at least on a quarterly basis. Once the timing of the mock drill has been determined, the steps below guide nurse leaders through preparations for mock abuse drills.

  1. Determine the frequency that the mock abuse drills must be completed.
  2. Determine when each mock abuse drill will occur. Because abuse doesn’t happen only on weekdays during the day shift, it’s important that the DNS varies the times and days of each drill so that they are conducted on all shifts, weekdays, and weekends, and all staff are included.
  3. Assign a moderator for the mock drill.
  4. Assign staff to play the roles of the resident and alleged perpetrator.
  5. If the drill is not occurring during an educational meeting, place staff playing these roles in a location where staff would intervene, such as a hallway, resident room, or the courtyard. Place a sign on each staff member playing a role that says, “I am a resident in an alleged abusive situation” or “I am a resident being aggressive toward another resident” so staff know to initiate the drill.
  6. If the staff member is not portraying the perpetrator as another resident, place a sign on that staff member stating, “I am a visitor perpetrating an abuse situation.”

Develop a script for each staff member playing a role during the mock abuse drill. The script must contain enough information that the staff involved in the drill know that this is an abuse drill.

Once preparations are complete, conduct the drill with staff. Be sure to have someone observe and take notes during the drill. This enables the team to conduct an accurate debriefing after the drill is over.

How Did the Drill Go?

Once the drill has been completed, conduct a debriefing with the team. This analysis of an event enables the team to reflect on the experience as well as their performance as individuals and as a team. The analysis and reflection empower staff to gain knowledge and improve their practice. Discussion questions posed during a debriefing may include:

  • What skills were staff competent in during the abuse drill?
    • Did staff understand what was happening and initiate action timely?
    • Were staff competent in their ability to de-escalate the situation?
    • Were staff confident removing the perpetrator when it was a staff member or a visitor?
  • What went well working as a team?
    • Did staff work well together to keep the resident safe?
    • Was communication between staff clear, concise, and understood?
  • What processes and resources supported staff?
    • Did staff know what steps to follow in an abuse situation?
    • Did staff follow the procedure for notification of abuse?
    • Is the facility abuse policy and procedure realistic?
    • Are staff able to comply with the policy and procedure?
  • What can be done to improve competencies?
    • Do some staff members need one-on-one education?
  • If any, what gaps in processes emerged?
    • Are the facility’s policy and procedures confusing or hard to follow? Do they need clarification or streamlining?
  • What can be done to eliminate these gaps?
    • Are resources easily available to staff?

Basketball coach John Wooden once said, “Practicing with purpose is the key to progress,” (The Blinkist Team, 2023). This encapsulates the reason to conduct mock drills in the nursing home: the drills are a purposeful means of working toward perfection so that when a real abuse situation happens, the team will be ready.

AAPACN has developed a Mock Abuse Drill Toolkit to assist the DNS with purposeful abuse training and staff evaluation.


Centers for Medicare & Medicaid Services. (2023). State operations manual, Appendix PP – Guidance to surveyors for long-term care facilities. https://www.cms.gov/medicare/provider-enrollment-and-certification/guidanceforlawsandregulations/downloads/appendix-pp-state-operations-manual.pdf

The Blinkist Team. (2023, August 3). Top 20 quotes about practicing: Ignite your passion and master your craft. https://www.blinkist.com/magazine/posts/top-20-quotes-practicing-ignite-passion-master-craft

Nursing2004. (2004). Mock code, real value. Nursing2004, 34(5), 12.

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