Observation Assistant Education

Claudette JohnsonManager of Nursing

Support Services

CONTINUOUS OBSERVATION ASSISTANTS

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 & safetyProvide safe environmentProvide reassurance and redirectionPrevent Falls and Injury

Keep patient:safe, engaged, in control, dignified

OBSERVATION ASSISTANT DOS AND DON’T

CAN

Ambulate steady gait patients

Set up trays

Unplug IMEDS only if directed by Nurse

Talk and calm patient down

CAN NOT

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

REASON FOR CHANGE: Handoff

Focus on

patient

recovery

Utilize OA efficiently

Patient safety

Cost effectivene

ssTherapeutic 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

Wrong treatment

Delay in Diagnosis

Adverse events

Patient dissatisfaction

Increase hospital cost

Increase length of stay

I N E F F E C T I V E

HANDOFFS R E S U LT

Leadership

Patient

Staff

COMMON HANDOFF ISSUESCAUSES OF

FA ILURE

Ineffective Methods

Time constraints

Change

Lack of focused research on healthcare and handoff

Lack of Efficiency

Lack of commitment

CAUSES OF SUCCESS

Open to change

Understand purpose of Change.

Preparedness and education

Commitment to making a difference

Management Support

Up-to-date information on the following:

Diagnosis, Care, Condition and ChangesLimited interruptionsSufficient time allocatedProcess for verification- repeat

back read back

HANDOFF IMPLEMENTATION

NURSE-SITTER HANDOFF TOOL

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.

Strategies to Keep Patient Safe if NO Safety Sitter Available

Use Activity Carts: Contents

Sensory Aids: Reading Glasses, 3 strengths, 3 of each Hearing aid batteries, 1 package of each, 3 strengths

Personal Care: Hand Mirror, Emery Boards

Games: Playing Cards, Dice, Decks of cards, Puzzle Books, Soduko, Word Search, Crossword,

Supplies: Coloring Supplies, Crayons, Coloring Pages, Stuffed Animals

Available on Unit Par Cart and order from S&D

Posey Activity Apron (#58018)

Hearing Amplifier (#58826)

Reorder from S&D for direct delivery

Activity Cart Point Persons and Cart Locations

2S CCU Denise Krull (US) 2S (Clean Utility Room)

3N CCU Denise Krull Storage Across from Break room and rm 312 (Lock Code 7302)

2E MOU Diane Brockland Electric Closet across rm 276

2E-S Terry Cihak (US) Clean Utility across rm 242

3E -S Terry Cihak (US) Supply Closet across rm 683

5E Glenda Torres Back Equipment Closet

6E Jana Overhead Bins across rm 683

6S Cindy Work Room

7S Nelia Chee Work Room

8S Jenny Newsome Work Room

9S Theresa Joseph Work Room

Kirchoff Building: Adult Mental Health D.Millard, RN

Activity Carts: LocationDiversion Activities

Safety at the Bedside: Objectives

You will:

Identify and recognize signs and symptoms patients may show when they are escalating

Verbalize when to call for help, who to call and what to do

Demonstrate and verbalize how to position yourself safely in a room

Identify objects and situations that will threaten safety of patient and of self

Safety at the BedsideGoal: Your safety first

Agitation

Anger

A clenched fists posture‐

Loud behavior

Yelling

Staring at the wall

Restlessness

Pacing

Talking fast

Recognize the warning symptoms

Position yourself safely

Stay calm and speak politely

Remove yourself from threat

Call for help

Signs of Escalation What to do

Body Language

Adopt a non-threatening pose

Arms relaxed and hanging down at the side, palms open below your waist and facing the person, legs relaxed.

Have hands visible (perceived as less threatening, if hands can be easily seen)

Don’t look directly into the patient’s eyes because this is threatening to many people—focus your eyes on the chin.

Remove sharp objects that can be used as weapon: Pens, pencils, letter openers, heavy decorative items

Remove large decorative jewelry

Do not wear stethoscope around your neck

Do not wear ID badge on a cord around your neck

Keep Room safe

Stay Calm

Speak slowly and politely.

Do not to show anger yourself—this is difficult to do, but showing your anger only worsens the situation.

Do not argue and do not agree with the patient if they have any delusions or bizarre ideas.

Allow the patient to “ vent” and just listen, without becoming judgmental—often, after a few minutes the patient may calm down on their own.

Position Yourself

Stand about arms length in front of him, but a bit off to the side

Do not face him directly. This is close enough to allow you to develop a rapport, but far enough away so that you do no threaten their personal space and they can’t easily touch or hit you

Don’t turn your back on them

Always approach the patient from the front and slowly

Position yourself closer to the door

Resource

Who Should You Call

Charge Nurse

Director

Administrative Supervisor

Security

Report to Hospital Committees

Violence In the Workplace

Safety Committee

Employee Health Service

Hospital policy:

Mr Strong•Dial 3333

•Announce Mr. Strong

•Location: Room, Hallway or Elevator

and Unit

WHAT IS ASSERTIVENESS

I T IS NOT…

Aggressive

Hostile

Confrontational

Ambiguous

Ridiculing

Welcome to the Float Pooland

Thank you for keeping yourself and our patients SAFE!

Questions???

Contact: Claudette at x 4241

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.