| Learning Objective #1: Profile patient behaviors considered at risk for injury | |||
| Learning Objective #2: Identify and implement strategies as alternatives to restraint use and one to one bedside sitters in high-risk patients |
Increases in acuity, high-risk patients, and liability concerns on medical-surgical units have led to the use of bedside 1:1 observation often performed by non-licensed personnel with only a few hours of training. The results are increases in non-productive work hours and a drain on staffing resources. A cost benefit analysis reveals that 1:1 observation costs more that $240,000 yearly. Nurses from two medical-surgical units, two pharmacists, and a physician formed to examine 1:1 observation problem. Using an evidence-based approach, they reviewed literature to identify high-risk patients and safe strategies based on best practice. Populations identified are those with confusion/agitation, impulsive behaviors, a tendency to wander, or an inclination to fall or remove tubes. Performance Improvement data revealed nursing measures included restraints plus 1:1 observation. Data compared fall volume, inadvertent line removals, and restraint use on patients with observation to patients without observation. Analysis demonstrated no decrease in incidents when observation was used. Data was analyzed on patients with agitation/confusion and indicated that patients were medically mismanaged. The team developed a plan to eliminate 1:1 observation while maintaining JCAHO guidelines and safety of patients at risk. Strategies included the identification of key interventions and the creation of pocket cards for staff listing those interventions. A “Spot the Dot” program was developed as an identification system. The team developed improved medical management interventions. Preliminary data indicates that 1:1 usage on the two medical-surgical units has decreased by 75% without increase of falls and inadvertent line removal. The team is currently using evidence to develop physician guidelines and preprinted order sets to reduce 1:1 coverage.
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