Safety Sitter Education Task Force September 30, 2012

1. ALL ABOUT SAFETY SITTERS Safety Sitter Education Task Force September 30, 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 • Familiarize and utilize strategies to keep patient safe

3. Safety Sitters • 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

4. Purpose of Safety Sitter Education • 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

5. Safety Sitter Algorithm • A Safety Sitter Algorithmhas 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

6. 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

7. Safety Sitter Algorithm

8. 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

9. Strategies to Keep Patient Safe

10. 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

11. Highlights of Delirium Protocol 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 • 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

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

13. Highlights of Protocols CIWA/DT Patients Animal Assisted Therapy CIWA/ DT Patients • 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

14. Highlights of Protocols Sleep Enhancement Protocols Patient Activity Progression 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

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

16. Role of Families • 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)

17. Unit Resources • 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

18. Role of 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

19. 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

20. Safety Sitter IS NOT 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

21. Scripting Guide for Staff

22. Conclusion

23. Questions Contact your leadership orSafety Sitter Education Task Force

24. 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