A report1 by a hospital security association, citing the lack of guidelines for healthcare sitters, recommends the following:

All staff who may take the role of patient sitter must attend training upon hire and annually thereafter. The training must include identification and management of aggressive behavior using one of the nationally recognized programs such as Crisis Prevention Institute (CPI), Management of Aggressive Behavior (MOAB), and Nonviolent Crisis Intervention (NVCI).

The training must take place prior to job assignment and include role-playing and scenario based training that includes the following:

  • verbal and physical signs and symptoms of agitation,
  • de-escalation techniques and fall prevention strategies,
  • suicide risk prevention strategies,
  • the proper process for removing dangerous objects and items,
  • the proper method to document monitored behavior,
  • use of deployed technology,
  • proper restraint techniques, and
  • how to summon assistance if needed.

Other recommendations include:

  • Facilities must also have clear policies and procedures for ordering, reviewing, and discontinuing the patient sitter. Facilities must define the intervals for reviewing the continuation of the patient sitter.
  • Patient sitters should provide services to the same patient for their entire shift. This allows the sitter and the patient to form a relationship, minimizes the number of staff that the patient has contact with, provides for continuity of care, and makes it easier for the sitter to identify a change in behavior.
  • Facilities must have clear policies and procedures on the type of activities that the sitter can do while providing the service. The use of electronic devices, reading, watching television, or any other distracting activities will divert the sitter’s attention from observing the patient. If the sitter is not monitoring the patient, the risk of injury to the patient and the sitter increases.
  • If warranted and clinically appropriate, the patient sitter may monitor more than one patient, preferably no more than two. The patient sitter does not have to be the same sex of the patient unless there is reason to believe the presence of the same-sex sitter will be beneficial. There are many times when the same gender providing the observation may support clinical outcomes such as during bathroom usage, showering, and intimate clinical interventions. Same-sex sitters will also provide more comfort to the patient’s roommate in a semi-private room.
  • A patient identified as suicidal must be placed in a facility-provided gown and searched for any contraband or items that could harm the patient or others. The patient should not be allowed access to their personal clothing or belongings. These items should be secured outside of the patient room. The room should be searched and objects such as staff belongings, phone, oxygen tubing, IV poles, plastic trash bags, medical supplies, trapeze, hangers, chemical solutions, foot pumps, BP cuffs, electrical devices, and extra furniture and supplies not in use should be removed.
  • Visitors must not be allowed to bring items in the patient room without prior authorization. This includes items such as food and drink, purses, bags, and clothing. To eliminate the introduction of potential weapons, the patient should not be provide with eating utensils and only allowed to eat finger food on paper products.
  • The patient sitter should be required to remain inside the room with the patient and not leave the patient’s side, especially when in the bathroom. Every second counts when responding to a situation that could lead to patient or staff harm or injury.

REFERENCE

  1. Richman CM, Sarnese PM. Patient Sitter Use Within Hospitals: A Cross-Sectional Study Final Report to the International Healthcare Security and Safety Foundation. December 2014. http://ihssf.org/PDF/patientsitterusewithinhospitals.pdf