Have you found safety checks to be an effective tool?

If yes, how?

Explain:

  1. We have been able to successfully interrupt a suicide by finding patients quickly with items tied around their neck.
  2. The staff then knows where the patient is at all times, and the patient knows that the staff is present and available. This seems to decrease the anxiety level on the unit and helps with milieu management.
  3. Assure patient that someone is checking on them
  4. It's critical to have frequent contact with patients not only for ensuring safety but for also being available to engage patients in conversation to more fully assess and support care.
  5. Catch unsafe behavior and to monitor ability to care for self. Is the person oriented etc...?
  6. It has increased the overall safety of the patients and also provides pt/staff interaction.
  7. Frequent staff presence helps maintain safety by giving patients a sense of security and staff availability for meeting their needs. It also promotes keen observation, early problem detection and prevention.
  8. While safety checks are helpful to be made aware of potential problems, they are also helpful for decreasing harm by an early intervention. By the staff noticing a change in behavior and reporting it to the other staff it's helpful to offer an early intervention rather than trying to deescalate an already formed problem.
  9. Safety checks have found items in the environment that are unsafe, have observed patients in questionable situations and further assessment done; they are also good to find contraband items such as cigarettes/lighters. We vary the staff doing the checks and the exact time frames may be less than 15 minutes (never more than 15 minutes) so that the patient can't predict the time of the check. On safety checks we have found a patient trying to chip out the window frame to escape and we have found attempts at harmful behavior such as cutting and hanging.
  10. Must vary the times as patients will time their self harm just before or just after rounds... nothing replaces vigilance, assessment and knowledge of the patient condition, history
  11. The violence scale has been particularly helpful in alerting staff to potential problems and to intervene early.
  12. On a couple of occasions pts have been discovered in the act of attempting to perform self harm, suicide attempts
  13. Not an assessment but an assessment is performed if indicated by observation
  14. Helps identify current behaviors and move to a more thorough assessment as indicated.
  15. It tells you if the patient is safe, interacting, isolating.
  16. The effectiveness of safety checks depends on how well they are done and where do they are done as frequently as are indicated by the patients needs
  17. Clinicians also have speed dial phone numbers to front desk (where guard sits when not doing rounds).
  18. I am not convinced rounds decrease self harm, but overall, we have identified when patients are beginning to escalate or there is a change in status which allows for early intervention. We have identified patients "missing" and frequent checks increase the chances of locating the patient before they can leave the grounds or engage in other high risk behaviors.
  19. We sometimes use a reverse check q15" for self-harmful behavior- so t e patient must come to the nurses’ station and complete the form with the nurse present to check in.
  20. All of these but only if checks are done correctly!
  21. Gather more patient data
  22. There have been incidents where a patient was attempting to harm self and we may not have caught this in time if not for safety checks.
  23. Yes and no. I think 15 minute checks should capture more clinically relevant behaviors as they did at another facility where I worked.
  24. Effectiveness depends partially on the patient behaviors
  25. Helps to enhance quality of observation
  26. It makes the staff aware of what is going on, prevents patients from hurting themselves or others, and alerts staff of potential safety issues
  27. Monitoring a patient by conducting safety checks provides a well rounded observation of that patient.
  28. Great insight to patients
  29. From a risk management perspective we are documenting that we are observing patients. We do not prevent all acts of aggression, self harm, suicide, falls, assaults, sexual behavior or elopements by observing patients. Hopefully, we are decreasing incidents, being alert to potential problems and providing a sense of safety for some patients.
  30. Actually found a young man with a towel around his neck with the intent to harm himself just in the last week.
  31. More to know what the patient is doing
  32. We have discovered clients attempting to leave, emotional crisis, and been able to monitor clients at risk more easily.
  33. Again....the options above denote you are only considering inpatient areas in terms of safety. I am responding as a Nurse/Director of BH at many levels, so encourage you to review safety practices at all levels of care.
  34. To make sure a patient doesn't need assistance (e.g. pt on fall precautions) and it gives the staff a more physical presence on the unit.
  35. Can't measure the self harm because you cannot measure what has occurred. We believe the "rounds" and checks help ensure a certain type of safety rather than best practice. My personal belief is it can excuse staff from spending more meaningful time with the patients to which they are assigned.
  36. For some patients it is frustrating because it thwarts plans they have, but for most, they are aware that they are being observed and they feel safer.
  37. The presence of staff doing the checks and being available on the floor at all times gives the clients a sense of support and that they will be safe. It affords the opportunity to observe behavior and thereby monitor changes that may indicate an impending crisis. This enables the staff to prevent the need to de-escalate someone by intervening before behavior escalates.
  38. This requires contact with the patient every 15-30 minutes at an interactive level. This is much what ACT teams do and intervene before escalation.
  39. If I thought that a pt could comply with waiting for assistance to ambulate, but was not sure, I could use more frequent checks to verify that pt can comply and plan is a safe one. If a pt tends to become irritable & aggressive when over-stimulated, I could have staff check on his location more often & re-direct him away from stimulating areas if he went to them.
  40. The person assigned to do that hour of checks will report to the nurse if any issues or notice of suspicious activity and may even have a pt move to the day room so we can be constantly observed.
  41. Accurate, complete documentation of the safety check flow sheets have been a key focus during sentinel event reviews, and subsequent investigations from CMS/State regulators.
  42. Staff is purposefully out in the milieu, creating a caring and potentially engageable presence.
  43. Lengths of stay are short and acuity is high. Essential to maintaining safety.
  44. The patient isn't as likely to harm themselves if someone is checking on them. It also helps us to be aware of patients that are isolating or the ones that are interactive with the staff and other patients.
  45. Staff has interrupted unsafe behavior during routine rounds
  46. However, it is a tool only. If patient has a history of harming behavior on a unit, will check more often.
  47. To know where the pt is-we are a large campus
  48. For the most part, safety checks are effective for the reasons stated above; however, we have had our share of self harm between check times.
  49. Conducing checks is one of the most critical functions of the nursing staff
  50. It allows a staff member to be accessible to the patients at all times, as they are roaming they look for possible safety or environment issues that may be on the unit
  51. De-escalation prior to the main event.
  52. Prevented harm to patients -have saved patients from hanging, etc.
  53. They are an essential tool in maintaining safety.
  54. We take turns with the clipboard, walking around, checking on everyone, even during nighttime-we try to be as quiet as possible, but it is 24 hours a day. Many patients have told us it makes them feel safer.
  55. Patient checks are a therapeutic tool in addition to the safety concerns
  56. They are effective tools as long as staff uses the information that is obtained. Many times staff does not look at the safety check information even if it is on a patient who is on special observations or line of sight.
  57. Staff visibility and presence in the milieu. Staff availability to patients. Documentation of patient participation in milieu. Documentation of hours of sleep.
  58. 15 minute checks have significantly decreased the incidence of near misses and untoward events.
  59. But unfortunately the checks are only as good as the tech performing them. As our techs do not assess, I did not check that box but if the tech felt someone warranted closer attention they are trained to notify the RN.
  60. Doing safety checks detects issues before there are problems, someone is on the unit and with the patients most of the time (our goal is all of the time), interventions to de-escalate patients can occur more quickly
  61. Safety and structure go hand in hand. Preventing contraband from being introduced on the unit, frequent visual contact with every patient, preventing environmental safeguards from failing or being manipulated into weapons is all part of assessment and prevention of harm.
  62. Allows staff to know patient location and actions with each check.
  63. We are here to help our patients’ recovery and learn skills/tools to cope with stress or illness. Our patient's want to feel safe and cared for.
  64. It is hard to do a check more than every fifteen minutes but a lot can happen between checks. Staff, unfortunately, is sometimes lax at doing checks, pt's still manage to harm themselves at times though it probably does help us to find it quickly and intervene. We do utilize 1:1 and LOS for those pts at increased risk.
  65. Face-to-face contact every 30 minutes, which is our minimum check, gives both the pt and the nurse the opportunity to have an expected non-threatening exchange. So the patient who might be hesitant to "bother" has a built in opportunity to ask a nurse who is focused on him at that moment. It also gives the nurse a chance to casually engage the patient if the nurse notes a change or has concerns.
  66. Safety checks in and of themselves have limited use and are not effective when used as the sole tool. It's some kind of hold-over from institutionalization and the corrections model. Standing by itself, checks have limited value. How might other approaches be used in conjunction with checks? What about checks on persons at risk, and then only in conjunction with wellness planning with enhancing a person's self care skills while the person is hospitalized? How might the use of wellness plans based on Copeland's Wellness Recovery Action Plan, reduce the need for whole-unit safety checks. Safety checks are not wellness checks - let's remain clear about it.
  67. We are in the process of developing additional components to document during the rounding process. This will include key words verbalized to patients to decrease anxiety, more thorough assessment of mental status, de-escalation techniques, more thorough environmental assessment, providing comfort measures, etc.
  68. Some patients are feeling safe I feel it is all staff's job to keep everyone safe on our unit. I think patients knowing we are watching them make most of them feel safe.
  69. To lessen the risk of elopement, to provide a more secure environment.
  70. Determines actual & potential escalations, behaviors requiring redirection, or intervention; fall risks, patients requiring assist with ADLs
  71. Provides continuity of care for the patient
  72. Yes...checks make staff visible in the community/milieu and patients know they will be checked on...staff is trained to ask questions, assess, check in etc and to report any concern to primary nurse
  73. Increased awareness
  74. Have found pt on rounds in the act of self harm or attempts
  75. On safety checks we have found patients engaging in unsafe behavior.
  76. If there is a change in the patient's condition it can be often be picked up during rounds and communicated to the patient’s assigned staff. Frequent monitoring also assures the patients that staff is around and available on a routine basis. Overall I think the 15 min checks decrease the incidences of self harm and improve assessment. On our units we use data from the rounds boards in our documentation about the patient’s activities for the day.
  77. They have prevented multiple suicide attempts on our behavioral health unit
  78. Keeps staff in constant touch with the patient
  79. Safety checks are our pilot tool for the patient safety. We take it as serious task
  80. If a patient is not able to sleep, participating in self harm, isolating and internally stimulated, we know.
  81. As you monitor the patient 24 hours any imminent danger is prevented- you see patient's activities, determine where they are at and can identify potential dangers.
  82. Staff does not perform safety checks as required and patients pick up on the inconsistencies.
  83. Probably serves as deterrent to self-harm behaviors for some pts; identifies potential problems before they become problems; also helpful for monitoring confused pts, pts at risk for falls, etc.
  84. It gets staff to go around to assess what is going on with the patients and also to make sure there isn't anything harmful around the unit.
  85. Pts are aware of timed checks and often act out when staff has passed.
  86. Staff does the paperwork but I find most times they are done haphazardly and problems erupt
  87. Clients in distress don't always need to level of security provided by One to One status. 15 minute safety checks provides more opportunities for coaching appropriate distress tolerance skills as staff are more acutely aware of the clients mood and able to intervene and provide support as needed and appropriate.
  88. We work with geriatrics, have patients with dementia and need to know what they are doing and where they are on the unit.
  89. I think this is the single most important activity done on the unit to be proactive in maintaining safety, and I view safety as the #1 priority of the unit.
  90. Keeps staff aware of where pts are and how they are doing, can help to avert a crisis, pts feel safer
  91. Useful in acute care to maintain knowledge of the status of patients
  92. Safety checks help us stay in front of behaviors or acuity in the milieu, if we can prevent it or decrease it before it gets to be an issue. Also the checks ensure the safety of pts who are having SI and actually try to implement a plan (IE interrupt a pt tying a sheet into a noose so they will be placed on 1:1 status, note pt burning self with cigarettes, so needs staff escort to smoke...)
  93. Assists with fall preventions, decrease risk of self harm behaviors, pts see/know know all staff is available to them.not only staff assigned staff
  94. It lets the patients know that we are there, that we are paying attention to them, that we are available if they need to talk & it keeps staff aware of potential problems and/or changes in pt moods/behavior.
  95. Often identifies patterns of isolation and has found pt's attempting self harm and suicide attempts.
  96. We have been made aware of items that had potential to be of serious harm to the patient.
  97. On most of our inpatient units, each patient is checked q15 min which allows us to detect problems early on in every location on the unit.
  98. changes in behavior & mood are noted & reported to Nurse, Patient may be changed from routine 30 min checks to higher level of checks, every 15 min. or line of sight or within arm’s reach
  99. Staff will notice if a problem exists; if the monitoring staff is a nurse’s aide, that person will bring the problem to the attention of a nurse. Patients have the opportunity to inform monitoring staff of any physical or other complaints.
  100. Sometimes we find someone crying, having a bad phone call, etc. and we can offer support to such a patient.
  101. Done by non-licensed, so not an assessment. Low rates of self harm, but still occurs with allowed items (I.E. pencils)
  102. All of the above - to know whereabouts on the unit, and behavior
  103. We hope that we always know where our patients are and what they are doing to prevent harm to themselves or others.
  104. Potential steps towards suicide attempts discovered & managed with safety rounds.
  105. We believe in early intervention, basically, prevention of crisis or incidents
  106. To keep a pulse on the patient community. Who is flirting, having poor boundaries, isolating, etc.
  107. Staff are visible in milieu, they can see if a pt is having difficulty and let the assign ED nurse know so further assessments can be made
  108. In terms of staffing resources, it is a nightmare. In terms of patient safety, it is IMPERATIVE!
  109. All of the above. Increases safety on the unit
  110. To use in assessment as checks are not done by clinical staff
  111. To intervene when help is needed ao everyone staff and patients alike remain safe
  112. All contraband can be confiscated, decreases at risk. The clinical staff can address issues and they are more aware of issues.
  113. Patients feel safer when they know that staff is aware of the environment and where all patients are. Harder for those who want to act out to do so when staff are monitoring the environment on a regular bases. Staff can intervene more quickly and assess situations as they arise.
  114. It's a good tool to visually see the status of the patient.
  115. Observe patients in "wrong" room (e.g. male and females, interrupt pts engaged in self-harm actions, observe changes in mental status sooner, etc.
  116. Being out and within the milieu while rounding allows one to be in tune with changes and can intervene early.
  117. Safety rounds keep a good pulse on the unit and the patient’s mood/affect changes as the day progresses
  118. Safety checks are a tool. The most important aspect of safety however is the staff being out with the patients. I would be interested in the use of special observations when intermittent observations is not enough to maintain the safety of the patient
  119. Keeps the staff visible for the patients. Many patients comment it makes them feel safe to see staff doing safety rounds.
  120. Often staff picks up on the subtle changes in patient’s behaviors or affect more quickly due to rounding. Also we are seeing higher fall risk patients and are doing intentional rounding on those patients every two hours for toileting and assistance with adls. But the q15 minute checks also help us with our fall monitoring.
  121. Face-to-face assessments are done by RNs on their rounds. Unlicensed personnel do the 15-minute checks
  122. Finding issues by being more deliberate in looking for them.
  123. I have found safety checks to be helpful to assess pts and be aware of problems.
  124. Improvement of condition or worsening
  125. These are brief visual observations, often done by security, CNAs and Techs who are taught to call RN for assessment for reportable changes.
  126. Rounding allows the patient the opportunity to interact with the staff and if there are problems at that time they can be readily addressed.
  127. AQides report any issues to RN's who then assess pt.
  128. Also be sure no one has eloped.
  129. Lets us know what is not being noticed and what needs to be more closely monitored
  130. Patient safety, staff safety
  131. Intentional observation of clients and milieu increases awareness of needs, issues and problems.
  132. Psych Assistant does Q15 min checks, advises RN of pt's status. RN also checks, depending on pt's condition.
  133. Assure no access to harmful objects and that no safety issues exist within the units.
  134. There have been several time in an investigation the rounds documentation was critical in protecting the staff
  135. Working nights, sometimes the only way to know what is going on w/a patient is to round. Able to visualize each patient & gauge status.
  136. It helps us to keep connected with the clients and head off potential problems.
  137. Safety checks provide an opportunity to see that the patient is 1) on the unit, 2) alive and breathing, and 3) offers an "in" for more extensive assessment with even the most resistant patients
  138. It provides a brief interaction with the patient
  139. They are helpful for all of the above reasons, also when the unit is busy it is good to know that a staff member is responsible for safety checks if I am busy with an admission, an acute patient, etc. I am not sure if I agree with our current policy of only documenting checks on the noc shift.
  140. Someone is always out in the milieu
  141. The downside is that there is so much focus on the timeliness and wanting real-time documentation that the focus is to get the checks done and not what the immediate needs of a patient are.
  142. The staff members are aware of potential safety concerns that might otherwise be undetected. They can also evaluate, as they walk through the unit to check on patients, if there are other environmental safety concerns to be addressed. They can get a feel for the milieu and how patients are interacting with one another that may present a concern.
  143. I believe safety checks can only be effective as the person doing them.
  144. We have even interrupted patient's attempting to harm self.
  145. We have caught suicide attempts in progress and prevented sexual activity between patients that was about to happen. Our unit is a rectangle shape with halls that extend out in 4 directions, so the frequency of checks is critical to keep track of what is going on in addition to the cameras.
  146. The staff like 1to 1 because they feel less worried about the high need individual while they run the rest of the unit. The staff sit and read magazines, there is little interacting or evidence of engagement. This is a problem in most public sector psychiatric settings. We do not know how to use the mental status information and milieu influences (support, norms, peer engagement, family. Relying on meds alone and "watching" may temporarily restore someone but there have been no new prosocial behaviors learned or behaviors to replace the aggression.