Claudette Johnson Manager 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 ID: 697483
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Observation Assistant Education
Claudette Johnson
Manager of Nursing Support ServicesSlide2
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 riskSlide3
ROLE OF OBSERVATION ASSISTANTSlide4
OBSERVATION ASSISTANT
DOS AND DON’T CANAmbulate steady gait patients
Set up traysUnplug 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 otherSlide5
REASON FOR CHANGE
: HandoffSlide6
BenefitsSlide7
WHO WILL BENEFIT
Slide8
HANDOFF
StakeholdersWrong treatmentDelay in DiagnosisAdverse eventsPatient dissatisfactionIncrease hospital costIncrease length of stay
INEFFECTIVE HANDOFFS RESULTSlide9
Common handoff Issues
Causes of FailureIneffective MethodsTime constraintsChange
Lack of focused research on healthcare and handoffLack of EfficiencyLack of commitmentCauses of SuccessOpen to change
Understand purpose of Change.
Preparedness and education
Commitment to making a difference
Management Support Slide10
Up-to-date
information on the following: Diagnosis, Care, Condition and ChangesLimited interruptionsSufficient time allocatedProcess for verification- repeat back read back
HANDOFF IMPLEMENTATIONSlide11
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:____________Slide12
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.Slide13
Strategies to Keep Patient Safe if NO Safety Sitter AvailableSlide14
Use Activity Carts: Contents
Sensory Aids: Reading Glasses, 3 strengths, 3 of each Hearing aid batteries, 1 package of each, 3 strengthsPersonal Care: Hand Mirror, Emery BoardsGames: Playing Cards, Dice, Decks of cards, Puzzle Books, Soduko, Word Search, Crossword,Supplies: Coloring Supplies, Crayons, Coloring Pages, Stuffed AnimalsAvailable on Unit Par Cart and order from S&DPosey Activity Apron (#58018)Hearing Amplifier (#58826)Reorder from S&D for direct delivery
Activity Cart Point Persons and Cart Locations2S 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 2762E-S Terry Cihak (US) Clean Utility across rm 2423E -S Terry Cihak (US) Supply Closet across rm 6835E Glenda Torres Back Equipment Closet6E Jana Overhead Bins across rm 683 6S Cindy Work Room 7S Nelia Chee Work Room8S Jenny Newsome Work Room9S Theresa Joseph Work RoomKirchoff Building: Adult Mental Health D.Millard, RN
Activity Carts: Location
Diversion ActivitiesSlide15
Safety at the Bedside: Objectives
You will:Identify and recognize signs and symptoms patients may show when they are escalatingVerbalize when to call for help, who to call and what to doDemonstrate and verbalize how to position yourself safely in a roomIdentify objects and situations that will threaten safety of patient and of selfSlide16
Safety at the BedsideGoal: Your safety first
AgitationAngerA clenched‐fists postureLoud behaviorYellingStaring at the wallRestlessnessPacingTalking fastRecognize the warning symptomsPosition yourself safely
Stay calm and speak politelyRemove yourself from threatCall for helpSigns of EscalationWhat to doSlide17
Body Language
Adopt a non-threatening poseArms 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 itemsRemove large decorative jewelry
Do not wear stethoscope around your neckDo not wear ID badge on a cord around your neckKeep Room safeSlide18
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 sideDo 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 youDon’t turn your back on themAlways approach the patient from the front and slowlyPosition yourself closer to the doorSlide19
Resource
Who Should You CallCharge NurseDirectorAdministrative SupervisorSecurityReport to Hospital CommitteesViolence In the WorkplaceSafety CommitteeEmployee Health ServiceHospital policy:Mr Strong
Dial 3333Announce Mr. StrongLocation: Room, Hallway or Elevatorand UnitSlide20
What is Assertiveness
IT IS not…Slide21
Welcome to the Float Pool
andThank you for keeping yourself and our patients SAFE!Questions???Contact: Claudette at x 4241Slide22
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.pdfNorthwest Community Hospital (NCH), (2011). Nurse- Sitter handoff tool. Nothwest Community Hospital. (2011). Pre-assessment of sitter needs survey.