Safety Sitter Education Claudette Johnson Manager of Nursing Support Services

Continuous Observation Provide a safe environment for patients whose physiological, mental and behavioral status puts them at risk of harming self and others. Used for patients: suicide, 5 point restraints & behavioral risk

Role of Observation Assistant Monitor patient behavior & safety Provide safe environment Provide reassurance and redirection Prevent Falls and Injury Keep patient: safe, engaged, in control, dignified

Observation Assistant Dos and Don’t CAN CAN NOT Ambulate steady gait patients Set up trays Unplug IMEDS only if directed by Nurse Talk and calm patient down Ambulate unsteady patients Feed patients Touch IMEDS without nurses' direction Hold a patients arm down (staff should use mitts or medicate patient) Know that PCTs who are sitting can provide PCT care. The nurse will need to update sitter for any changes. Sitters will be passing information to each other

Focus on patient recovery Reason for Change Focus on patient recovery Utilize OA efficiently Patient safety Cost effectiveness Therapeutic presence

Benefits Keep patient safe Keep patient and family engage Keep patient in control Facilitate patient Recovery Utilizing OA efficiently

Who will Benefit Family Staff PATIENT

Handoff Stakeholders INEFFECTIVE HANDOFFS Leadership Patient Staff Wrong treatment Delay in Diagnosis Adverse events Patient dissatisfaction Increase hospital cost Increase length of stay

Resources Human factor Time constraints Volume of Information Gaps in communication Limited training Confidentiality Volume of Information Time constraints Human factor

Common handoff Issues Causes of Failure Causes of Success Ineffective Methods Time constraints Change Lack of focused research on healthcare and handoff Lack of Efficiency Lack of commitment Open to change Understand purpose of Change. Preparedness and education Commitment to making a difference Management Support

Implementation Up-to-date information on the following: Diagnosis, Care, Condition and Changes Limited interruptions Sufficient time allocated Process for verification- repeat back read back

Nurse-Sitter tool Purpose to improve safety as well as patient and staff satisfaction.  Purpose Patient: Room # _____ Date ____Shift______ Hand off information for any sitter will include: What is wrong with patient? ____________________________ Why do they need a sitter? _____________________________ Diet/ fluid restrictions: _________________________________ Activity- independent or with assist ______________________ Specifics about their care ______________________________ Time for their meal breaks, what time they are expected back - SPECIFIC TIME _______________________________________ Who will relieve them for their break? ____________________ Phone number: Charge: Break Relief: ____________ OA/PCT Signature:________________ Date:____________

Sitter Handoff Guidelines Hand off information for any sitter staff will include: 1) What is wrong with patient? Why is a sitter needed? (Hip replacement but is sun downing tries to get out of bed after 7 pm) 2) Diet/ fluid restrictions (NPO, 1 cup of water every shift) 3) Activity- independent or not (can get up by himself, can get up safely with walker) 4) Specifics about their care (examples: quick with hands must watch IV or Foley, bolts out of bed, confused, watch for visitors) 5) Time for their meal breaks, what time expected back -MUST be a SPECIFIC TIME (not 1 hour from now but instead 0445) 6) Who will relieve sitter for their break (Julie, PCT and her phone # is____) - OA for suicides have to watch the patient at all times and should not be standing by the door looking for help.

What is Assertiveness IT IS NOT… Aggressive Hostile Confrontational Ambiguous Ridiculing

Pilot Study Begins February 08 to March 08, 2011 Forms available in the Float Pool room Send completed sheets to Claudette Johnson Questions: call Claudette at x.7959

Survey to assess the success of the PILOT STUDY For: all OAs random RN/ PCT Deadline: October 1, 2011 Return to: Claudette Johnson 3W

Change For Safety And more importantly, change for our Patient

References Agency for Healthcare Research and Quality (2005). 30 safe practices for better health care: Fact sheet. Retrieved March 19, 2011, from http://www.ahrq.gov/qual/30safe.htm Institute of Medicine. Committee on Quality Health Care in America. (2000). Errors in health care: A leading cause of death and injury. In L. Kohn, J. Corrigan, & M. Donalsdson (Eds.) To Err Is Human: Building a Safer Health System. Washington, D.C: National Academy Press. Joint Commission on Accreditation of Healthcare Organizations. (2008). 2009 national patient safety goals [electronic version]. Joint Commission Perspectives, 28(7), 12. Retrieved March 19, 2011, from http://www.jcrinc.com/common/PDFs/fpdfs/pubs/pdfs/JCReqs/JCP-07-08-S1.pdf Northwest Community Hospital (NCH), (2011). Nurse- Sitter handoff tool. Nothwest Community Hospital. (2011). Pre-assessment of sitter needs survey.