All About Safety Sitters Safety Sitter Education Task Force September 1, 2012

Objectives The learner will be able to… Identify what actions should be taken prior to requesting a safety sitter State how to request a safety sitter Utilize strategies to keep patient safe

Safety Sitter Definition: A safety sitter is an individual who has been trained to sit with a patient to keep them safe A safety sitter may be an Observation Assistant or a Patient Care Technician (PCT). When safety sitters are PCTs, they may perform functions of a PCT for the patient they are sitting for For the purposes of this training, we are not referring to sitters used for : suicide precautions or behavioral restraints in the inpatient setting

Safety Sitter Education The need for safety sitters was increasing. To use our resources more efficiently, we want to use safety sitters when absolutely necessary. This training has been developed to inform you of resources available to use before a safety sitter is requested.

Resources to Keep Patients Safe Safety Sitter Algorithm Rounding- Culture of Caring Pain Management protocol Delirium Protocol Delirium Assessment Algorithm Fall Prevention Protocol Restraints Sleep Enhancement protocol Patient Activity progression Protocol Bladder Scan Policy Animal Assisted Therapy Thermoflect blanket (Policies available on the intranet under nursing-> safety sitter tab)

Safety Sitter Algorithm Our hospital has created an algorithm to follow for keeping patients safe, “Safety Sitter Algorithm”. The algorithm, policy and resources are available on the intranet site tab “Safety sitter” The following slides will highlight key points in the algorithm

Safety Sitter Algorithm The initial steps in using the algorithm involve determining a change in a patients behavior. The nurse will: ~assess the patient and attempt to identify the cause of the behavior ~address the cause with an appropriate intervention/strategy.

Addressing Patient Change in Condition There IS a change in the patient’s behavior Collaborate with the doctor and charge nurse This may involve additional diagnostic testing, a MET or even a transfer to a more appropriate unit This is NO change in the patient’s behavior and there is a need for constant observation Initiate appropriate strategies to keep patient safe Use your resources Consult with families to see if they can be of assistance

Initiate/Continue Strategies for Patient Safety Rounding – 4P’s Use Delirium Protocol Use Fall Prevention Interventions Use of thermo-flect blanket Use of activity or book cart Music therapy Pet Therapy Sleep Enhancement Protocol

Initiate/Continue Strategies to Keep Patient Safe Use of distractions for the elderly Walk patient Review “Who Am I” Assure sensory aids are used- battery for hearing aids, hearing enhancer,glasses Consult with Geriatric CNS Consult with Psych for mental health issues

Consult with Families Often times, families are an untapped resource When patients become difficult to keep safe, families should be brought in to assist to keep the patient safe Families may know strategies to keep patient calm and safe Families may be able to sit with the patient Families may also want to hire outside assistance and may be provided with an Agency Sitter list (List on the intranet)

Use Your Resources Charge Nurse Manager CNS/Clinical Educator Administrative Supervisors Julie Knight Claudette Johnson NICHE Module Safety Sitter Resource book Chaplains

Role of the Administrative Supervisor When the Administrative Supervisor (AS) is called, they will consistently ask: Patient behavior Intervention Attempted Family available How will you keep patient safe if sitter is not available The AS can help determine if an NCH sitter is available

Safety Sitter IS Available If a sitter is provided, the unit will have give sitter report: Nurse must give sitter handoff sheet to sitter and give report to sitter on details outlined on the sitter handoff sheet Identify PCT resource for sitter for sitter breaks and other issues Provide extension number for charge nurse and patient’s nurse to sitter Round on patient every hour Sitter usage needs to be reassessed every 2 hours Notify supervisor of changes in sitter need

Safety Sitter NOT available If a sitter is not available, the unit will be asked: Assign own unit PCT or rotate watching patient. Consider diversion activities Consider Bed alarm, mitts and other device Consider use of restraints as last alternative

Use of Delirium Protocol The Delirium Protocol is an excellent resource to assess patients who may be developing delirium. It should be used for: Assessing patients at risk for development of delirium Identifying possible precipitating factors for development of delirium and possible nursing actions Identifying appropriate interventions for prevention/treatment of delirium Comfort and Spirituality Meals and hydration Mobility Communication and orientation Relaxation and Sleep Medication Management

Delirium Protocol Strategies Encourage participation of family at the bedside Offer religious objects and reading materials Offer toileting every 2-3 hours Pain assessment- appropriate for cognitive status Prevent or treat constipation and/or urinary retention Assist with feeding and provide companionship with meals Early mobilization and regular exercise as medically allowed Range of motion exercises 3 times daily for patients on bedrest Maintain self-care- allow patient participation as much as possible Ensure hearing aides and glasses are used and in working order. Offer hearing enhancer or magnifiers. Orient to the environment- use reminiscence, life review & conversation Keep patient informed and allow to express emotions Recreational and relaxation activities- Use activity cart, breathing techniques, music, hand massage Sleep promotion, non-medication alternatives- music Consult with physician about appropriate medication management

Conclusion There are many ways to keep our patients safe and NCH has developed a comprehensive list of resources to be used by bedside clinicians. It is key that all staff understand the resources available for the complexities of keeping patients safe If we all work together, we can make a difference For questions, please consult the leadership on your unit and/or the safety sitter task force