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

2. 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

3. 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

4. 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.

5. 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)

6. 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

7. 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.

8. 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

9. 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

10. 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

11. 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)

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

13. 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

14. 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

15. 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

16. 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

17. 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

18. 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