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 sitter2. State how to request a safety sitter3. 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

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

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 ProtocolsRounding

& Pain Management

Culture of caring - 4 PsPain- Assess pain and medicate PRNPotty- Offer toiletingPosition patient every 2 hoursPresence

Fall Prevention

Assess patient risk Identify patient at risk Use of yellow socks Call light accessible Bed alarm as

necessary

CIWA/ DT PatientsCIWA/DTPatients

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 ResourcesUse of Care /Book

CartsUse 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

Conclusion

Contact your leadership or

Safety Sitter Education Task Force

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.

10.21.12