Adolescent psych 1:1 management

[Zen APRN]

I work on a 22 bed adolescent psych unit and we have a very high amount of 1:1s. I am looking alternative strategies for managing these high acuity adolescents. We have a structured program but are typically short staffed as seems to be the norm in our field. I would love to hear what alternative measures other facilities use to prevent and/or decrease the need for 1:1s.

[Davey Do]

PeacefulHealing:

Good question: How can we assure the individual patient and other's well-being without expending extra staff resources? Are there alternative methods that can be utilized?

The rationale for a Patient being placed on a 1:1 staus is probably the most important factor. Usually the reason is due to Safety. You know, the Patient is a threat of harm to self or others or some such thing.

My guess is that the Patient's need to be put on such a status is implemented only after other intervention methods have been attempted. Interventions, such as a Contract for Safety, Close Observation, and the like.

One Intervention I'm faintly aware of is is sometimes implemented at Admission. If the Patient has a history, from previous admissions, of requiring intense interventions, they recieve no priviledges with the Mainstream Population until they can prove themselves worthy. Sometimes this Intervention is implemented during their Hospital stay. It is NOT meant to be a punishment, merely a type of Behavior Mod, if you will. Motivated Individuals transition into the Mainstream Program with better outcomes, so I'm told.

It'll be interesting to read how others deal with this resource-expending situation.

Good luck to you in your endeavor, PeacefulHealing.

Dave

[Jules A, MSN]

Discharge anyone with a Axis II diagnosis, lol. Seriously though most of ours on 1:1 are there due to superficial cutting which is something that can be made worse by the extra attention of having staff at their disposal. If it becomes problematic the things I have seen work include having the assigned staff only observe the patient, no talking to them, playing cards etc. In especially dire situations we have gotten a Drs. order to ignore cutting unless the patient was in acute danger from the item they were using to cut. Often loss of all personal items any of which can be used to cut and put into paper gowns helps decrease the novelty of "feeling like hurting myself". Can you tell I'm working with teenage girls?

FWIW I am not talking about doing this with a patient with serious SI or one that is aggressive with peers.