Six elements key to patient sitter program
Falls research led by Michelle Feil, MSN, RN, senior patient safety analyst with the Pennsylvania Patient Safety Authority in Harrisburg, found that these six program design elements were associated with successful patient sitter programs:
- a process for requesting and discontinuing sitters;
- patient eligibility criteria;
- a pool of sitters;
- criteria for sitter qualifications;
- a sitter job description with expectations for sitter behavior and responsibilities;
- a training program for sitters.
In addition, she found that facilities might be able to decrease patient sitter use while helping to reduce rates of falls with harm by incorporating these elements:
- Designate staff responsible for overseeing the sitter program and/or assessing patients prior to initiating one-to-one observation (psychiatric liaison nurse, geriatric clinical nurse specialist).
- Outline a process for requesting and discontinuing sitters.
- Define patient eligibility criteria.
- Designate a pool of sitters.
- Outline criteria for sitter qualifications.
- Outline expectations for sitter behavior and responsibilities that include the following:
- reviewing pertinent clinical information, the reason for observation, and the plan of care with the nurse assigned to the patient and communicating regularly throughout the shift to report observed behaviors indicating either continued need for, or ability to discontinue, use of one-to-one observation;
- documenting observed behaviors and interventions provided in the course of performing one-to-one observation;
- maintaining toileting schedules for patients able to use the toilet or bedside commode;
- remaining with patients while in the bathroom;
- staying within arm’s reach of patients whenever appropriate (the nurse and the patient sitter will need to assess when remaining within close proximity to the patient might be inappropriate because it might increase agitation in some patients);
- ensuring a safe environment (remove clutter, keep items within patient’s reach);
- providing a proper handoff to another staff member, completed in the presence of the patient, when patient sitters must leave the patient;
- focusing on observation of the patient and avoiding non-work-related activities that might distract from care of the patient (personal calls, cell phone use, reading).
- Design a training program for sitters that provides education on the following:
- safe patient handling techniques;
- behavior management strategies for de-escalating agitated patients;
- diversional activities (e.g., activity aprons, crafts, magazine reading) to engage patients, particularly those with cognitive impairment.