Safety Sitter Education Task Force September 30, 2012 ALL ABOUT SAFETY SITTERS

The learner will be able to… 1. Identify what actions should be taken prior to requesting a safety sitter 2. State how to request a safety sitter 3. Familiarize and utilize strategies to keep patient safe Objectives

Definition: A safety sitter is an individual trained to observe and sit with a patient to keep them safe A safety sitter may be an Observation Assistant (OA) or a Patient Care Technician (PCT). PCT safety sitters should 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 Sitters

To provide strategies in addressing the increasing need of safety sitters To inform staff of available resources in addressing the safety needs of patients To efficiently use our sitter resources Purpose of Safety Sitter Education

A Safety Sitter Algorithm has been created as a reference to guide staff in identifying patients needing safety sitters The algorithm, policy and resources are available on the intranet site under: Contents  Safety Sitter The following slides will highlight key points in the algorithm Safety Sitter Algorithm

The initial steps in using the algorithm involve determining patient’s behavior. The nurse will: ~ Assess the patient and attempt to identify the cause of the behavior ~ Address the cause with an appropriate intervention ~ Notify the Administrative Supervisor if suggested strategies are ineffective Safety Sitter Algorithm

There IS an improvement in 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 improvement in patient’s behavior – Initiate appropriate strategies to keep patient safe – Use your resources – Consult with families to see if they can be of assistance – Offer private sitters if needed Addressing Patient Condition

Use of Thermo-flect Blanket Use of Activity/Book Carts Bladder Scan Protocol Patient Activity Progression Protocol Pain Management Protocol Fall Prevention Protocol Delirium Protocol Rounding Use Unit Resources Offer use of Agency sitters Ask Family to stay Consult with Mental Health Staff Consult with Geriatric APN Sleep Enhancement Animal Assisted Therapy Music Therapy Strategies to Keep Patient Safe

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

Highlights of Delirium Protocol Encourage family participation Offer religious objects and reading materials Prevent or treat constipation and/or urinary retention Offer toileting every 2-3 hours Provide companion and assist with feeding and meals Use relaxation activities- activity cart, breathing techniques, music, hand massage, Sleep promotion, non-medication alternatives- music Orient to the environment- use reminiscence, life review & conversation. Review “Who Am I” Use of stuff animals for the elderly Early mobilization and regular exercise as medically allowed Pain assessment Range of motion exercises 3 times daily for bedrest patients Allow patient participation Ensure hearing aides and glasses are used and in working order. Offer hearing enhancer or magnifiers. Consult with physician about appropriate medication management Consult with pharmacy regarding medication interaction Consult with Geriatric APN – Julia Knight

Highlights of Protocols Rounding & Pain Management Culture of caring - 4 Ps Pain- Assess pain and medicate PRN Potty- Offer toileting Position patient every 2 hours Presence Fall Prevention Assess patient risk Identify patient at risk Use of yellow socks Call light accessible Bed alarm as necessary

CIWA/ DT Patients CIWA/DT Patients Highlights of Protocols Purpose: provide direction and medication management of patient in DTs Highlights ~Medicate every 2 hours ~Follow CIWA protocol Purpose: provide companionship and diversion for patients Highlights ~ call x. to request for AAT visit ~Follow AAT guideline on what is appropriate ~ no visit with isolation patients Animal Assisted Therapy

Sleep Enhancement Protocols Patient Activity Progression Protocols Highlights of Protocols Purpose: assist patients in promoting relaxation conducive to sleep Highlights ~ Use of music ~ Promote a quiet atmosphere ~ Medication, if appropriate ~ Bath/Backrub at night ~ Warm milk Purpose: Increase activity to avoid boredom and relieve restlessness Highlights ~ ambulate when appropriate, if restless ~ restless in bed- get patient up to a chair

Purpose: Provide diversion activities to occupy patients time Locations- Each unit has one. refer to each unit for location Purpose:Provide warmth and comfort Follow thermoflect policy Highlights of Resources Use of Care /Book Carts Use of Thermo-flect Blanket

Families are an untapped resource Families can be brought in to assist in keeping their loved one safe – Families are familiar with patient routines at home and may know strategies to keep patient calm and safe – Familiar voice or face can be calming to patients Families can hire outside assistance and use an Agency Sitter (List on the intranet) Role of Families

Unit Charge Nurse Unit Manager Unit CNS/Clinical Educator Unit GRN (Geriatric Resource Nurse or Gero Certified RNs) Geriatric APN (Julia Knight x. ) Consult with Pharmacy (x. ) Consult with Mental Health (x. ) NICHE Module Safety Sitter Intranet Site (Intranet->Content-> Safety Sitter education) Administrative Supervisors (x7933) Safety Sitter Education Task Force Members Unit Resources

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 Role of Administrative Supervisor

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 IS Available

If a sitter is not available, the unit will be asked to: – Ask family to stay with patient – Assign own unit PCT or rotate watching patient. – Consider strategies & diversion activities – Consider Bed alarm, mitts and other device – Consider use of restraints as last alternative Safety Sitter IS NOT Available

Scripting Guide for Staff

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 for staff to be familiar and understand the strategies and resources available for the complexities of keeping patients safe Working together can make a difference Conclusion

Contact your leadership or Safety Sitter Education Task Force Claudette Johnson Lori BalekZita Nadal Denise Krantz Shime Herrera Mary Webb QUESTIONS

Thank you for your commitment to improve patient care by effectively utilizing staff, maximizing use of our resource and more importantly, keeping our patients safe