I am in need of ya'lls experience with sitter usage on med-surg areas and telemetry areas. I am manager of about 70-ish total telemetry beds. Half of these are informally considered as step-down ICU beds. Our current nurse patient ratio is about 1:4-6 depending on acuity and shift and all the other usual variables. The patient population is mixed 50/50 medical/surgical, with half being open hearts, s/p MI's, CHF, acute CVA, post interventional caths.
My inquiry is this: How does your facility use sitters as a replacement for restraint use? Where do the FTEs come from?...are they paid out of your cost center and therefore a negative impact on your productivity? In my experience, we use alot of sitters...some pay periods in excess of 600-700 hours...with many of these sitters being used to keep patients out of the critical care areas, for example: an OD who otherwise would go to the ICU for 1:1 observation is placed with a sitter in my post interventional area where the n
ratio is 1:2-3, or the patient who is siezing and without a sitter would be in the ICU. There seems to be an opinion higher up in the organization that these are cute little old folks with oldtimers disease...that if I put mittens on these patients, or close the door to their room so they won't wander that this will fix it. After I stop rambling here I'm going to write a data collection tool to provide meaningful information to convince those above me that their ideas may not meet our needs. I'd love to hear from anyone having similar experiences...thanks!!
Dec 23, '01
JCAHO set the rules about 4 side rails up = restraints. We have some beds that have different controls on each of the 4 side rails, but have to leave a pair of side rails down even if it makes the controls inaccessible to the patients and the nurses. My unit (CV-ICU) had a history of minimal restraint use, but we still got nailed by them last June or July (before they said 4 siderails were restraints). They didn't like the way we got our MDs to order restraints daily; it had to be EVERY 24 HOURS!! and the doc was to come in and evaluate the pt. themselves before we could apply restraints. YEAH RIGHT! I posted a thread on it at the time; later, JCAHO backed down and said we could restrain pts. before the doc saw them. We had quite a write-in campaign at the time, and I wrote to my state senators and congressmen about this rule. Something helped, but then the rule about the side rails came out (I doubt if they were connected, though). We use sitters frequently, but I don't think they count as part of our staff. I don't know how they are budgeted for.
Last edit by Jenny P on Dec 23, '01