Im curious about the 1:1 vigilance

  1. How does your hospital do it, and who does it? What's the apropiate distance that the staff must have from the patient? During nightshift while the patient sleeps, do they allow the staff to read a book or keep his mind busy?

    From where I work it's one hand distance and is usually the assistants that do it. However I hear constant complains that the distance is too close, and that it's not safe for the staff. Another usual complain is on nightshift when they want the assistant to watch the patient, without doing anything else besides, filling the activity log, which must be documented every 15 minutes. I find this abusive, because they expect me to make sure they don't fall asleep, but then they don't want them to do anything besides staring at the patient for an 8 hour shift!!

    Any online guidelines or a website explaining the 1:1 vigilance would be apreciated too!
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  2. 11 Comments

  3. by   misty1998
    At the hosp I work at, it all depends on why the Pt is 1:1. Usually we are somewhere in the room, how close we stay to the pt depends on if they are a fall risk an/or confused or if they are on suicide precautions. I work night shift, but I know day and night shift is allowed to read, watch tv, work on crossword puzzles etc... Usually its the techs ( CNA's) that sit w/ the pts. The nurses are really good about coming in every 3-4 hours and giving you a short break and of course you get your 30 min meal break also.
  4. by   Katnip
    Our techs do 1:1 and nobody does it for more than a couple of hours at a time, including night, so nobody is at any major risk of falling asleep. They can get up and around often enough. We usually have enough techs to do 1:1 on two or more patients without too much trouble. That's one thing they've done right.

    Distance depends on why the patient is 1:1 and usually left to the discretion of the tech. standard with any patient is arm's length, but if you know they aren't violent you can get closer. Same with all patients.
  5. by   BoogiePop
    It puts me in a stressful situation. For my part, I won't scold the assistants for reading or doing other stuff while watching the patient, because I can't expect them to do something that I know not even I will be able to do. Pretty sad too cause I study nursing to care for the well being of human beings not just my patients, and it definetly can't be healthy sitting 8 hours on a chair without sleeping or doing anything else for the whole week.

    It would really help if you know of any website or online resource that talks about the 1:1 vigilance and how to perform it properly. The administrators from my hospital, say they do that bacause its part of the Joint Commision Patient safety goals, but there has to be a better way to reach that goal that doesn's put a person under all that stess.
  6. by   epg_pei
    I haven't done that much 1:1. The psych attendants usually do it, with an RN or LPN co-assigned. Everyone stays outisde the room. Usually there's at least 5-6 feet between pt and staff. I don't feel comfortable any closer. I see people reading and even watching DVDs. I like to keep a closer watch than that, you never know what is going to happen. If it hits the fan while you're watching a movie or likewise, chances are you'll be in very deep you-know-what.
  7. by   Thunderwolf
    There are 2 different types of 1:1's:

    1. Loose 1:1...a staff member in same room with patient at all times.
    2.Tight 1:1....a staff member at arm length to patient at all times.

    Hope this helps
  8. by   moonlighting
    At the hospital I work at 1:1 observation (during the day) is within arms length and the Mental Health Techs are assigned. At night (when the patient is in bed asleep) 1:1 is a little more liberal in that the tech's can sit in the doorway of the patients room for the observation. Also, the MHT's document (written like NN's) every hour day and night. In my experience 1:1 expectations can vary slightly so it depends upon what the hospital policy is where you are employed at. Hope this helps.....
  9. by   sarmedic70
    Good and interesting responses. I would first and foremost check with what your facility's protocols/procedures are with regards to the 1:1. Each facility will essentially vary a bit. At our facility, a state psych hosp, the 1:1 can depend upon the situation of the patient. If the patient listed as "assault precaution",then the rule of thumb for safety is not closer than an arm's length away if the patient opts to want to strike out. If the patient is on a "suicide precaution", the 1:1 is different. Sometimes the 1:1 can be right next to the patient or just keep the patient within constant eyesite. That is the way it is with our kids. Our psych techs are awesome and very good as to knowing what they need to do, and keeping safe, under the circumstances. At night, when a patient is sleeping, they are generally under DOS watch. The psych tech can be at the tech station and watching on the monitor. We do have some situations with 1:1/DOS that the tech must remain directly outside of the patient's room. They are never ever IN the patient's room for safety reasons. We will also have 2:1's from time to time. Techs assigned to 1:1/DOS should always be alert enough to be watching out for the safety/welfare of the patient at all times. It is up to the Charge RN on duty to make the decision/judgement as to just what all the tech can/cannot do during his/her "watch" and it will also be taken into consideration the patient involved.

    So as one individual posted, it will vary from hospital to hospital, and even within a particular hospital, the 1:1 will vary depending upon the status/situation of the patient.

    I hope you will be able to get clarification from the facility you work with regards to how they conduct the 1:1's.

    Good luck!
  10. by   PRNMEDS
    We have 1-1 eye contact, and 1-1 ARMS LENGTH eye contact. The later is for our very impulsive, self-injurious. for our regular 1-1 staff generaly sits in doorway of room. Also often the order will be for "While Awake" so that when patient goes to bed at night staff has a little more flexibility and monitors every 5 minutes.
  11. by   sarmedic70
    Most definitely there are "variations on a theme of 1:1". Since I am the charge RN for a pediatric unit, the arm's length may or may not be appropriate........we just have to gauge the situation. We do teach the kids proper "boundaries", and when they breach that, we remind them. They are generally very good about it. We also have a "silent watch".......it is kind of DOS but the child is unaware of it.

    Happy Days!
    :-)
  12. by   bollweevil
    Quote from moonlighting
    At the hospital I work at 1:1 observation (during the day) is within arms length and the Mental Health Techs are assigned. At night (when the patient is in bed asleep) 1:1 is a little more liberal in that the tech's can sit in the doorway of the patients room for the observation. Also, the MHT's document (written like NN's) every hour day and night. In my experience 1:1 expectations can vary slightly so it depends upon what the hospital policy is where you are employed at. Hope this helps.....
    :yeahthat: I was taught arm's length, in same room, in view, or at doorway, depending on MD's order.

    We make MD specify exactly what he or she wants. We have some staff who love to sit on 1:1, others who fall asleep so we have to change them frequently. They are not supposed to do anything like read or watch TV. They must be totally about the patient every second. Boring, too intense. But vital.

    Rarely do nurses do it. Almost always the techs.
  13. by   faithful11
    Where I work, any level of care that has been trained to monitor 1:1 observation is assigned to do so. Licensed, NonLicensed, PreLicensed etc. The distance depends on the individual patient. Arms length, 6 feet, line of sight etc...are all distance specifications I have seen. There are to be no barriers between the staff and the patient (i.e. the patient cannot be locked up inside the phone booth with the staff outside and the door closed). It doesn't matter the shift either, AM, PM or NOC--the doctor's order is what we go by.

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