Can Staff Close Their Eyes While On 1:1?

[Vito Andolini]

Our staff insists that it's ok to close their eyes and even sleep on 1:1. I say no. I say the policy requires direct visualization at all times of the patient, being within arm's length, not doing anything like reading, watching a DVD, nothing, and that these rules are inviolate.

[Atheos]

As far as I am concerned closing eyes should get a) Severe warning b) termination. I mean who sleeps at work.

Noow if they are passing out because of exhaustion, that could be a different story, but then they should be counseled on working too.

[Thunderwolf, MSN, RN]

Our staff insists that it's ok to close their eyes and even sleep on 1:1. I say no. I say the policy requires direct visualization at all times of the patient, being within arm's length, not doing anything like reading, watching a DVD, nothing, and that these rules are inviolate.

You are indeed correct.

The purpose of a 1:1 is to protect a patient from his/her actual/potential behavioral tendencies that places that patient at risk for self harm or harm to others. If your facility has a written SOP, it needs followed to the letter. If there is not a written SOP, one needs developed and initiated. The 1:1 is an added layer of structure on the milieu regarding one particular patient. To not follow it exactly not only places that patient at risk for self harm...it also places additional risk to the other patients and staff as well. Your unit is only as safe as your milieu. 1:1's are part of that process. Sleeping on a 1:1 watch warrants an automatic written warning. If it occurs again by that same individual, it warrants being sent home without pay for a prescribed amount of time. A third time warrants termination. Actually, this is quite lenient. Lastly, if a 1:1 sitter does not follow the facility's standards of 1:1 and a patient is harmed/injuried/killed...it places your facility at risk for a big time lawsuit...in that case, the question is sort of moot...the offending staff member would most likely be fired.

In a nutshell: 1:1 watch is for your safety as well as for the patient. Short change the process, someone will get hurt...one way or another.

[Vito Andolini]

Sadly I have seen 1 on 1's that weren't being done properly and ended with incidents that should never have happened. We try to rotate the staff often in hopes of keeping them on the ball.

Do you go wake up the sitter? Do you catch flak for doing so? Does your Admin back you up? What became of the sitters who allowed these things to happen? Were the sitters asleep, resting their eyes, or in some other way inattentive and derelict in their duty?

Or did the patient just move too quickly for the alert, on-the-ball sitter to prevent trouble? That can certainly happen and is not always preventable.

Policy states that staff are to "continuously monitor" the client. The policy really should say clearly that there can be no closed eyes because the point could be argued that hearing is being employed to monitor. The aide's view is that the snoring patient can be monitored audibly. I say people can fake snoring., therefore, staff eyes need to be open. Closed eyes can lead to sleeping and how would anyone know that now the staff is asleep, even if he or she was awake a few minutes ago? And snorers don't necessarily snore all night, even when sleeping.

We also trade off frequently, leaving a sitter on 1:1 for no more than an hour at a time. We still get sleeping sitters. It is maddening and scary.

The thing is, nothing bad has ever happened at our place when sitters have slept. I almost wish something would. Not really, of course, but I bed policy enforcement would increase if it did.

The whole issue is very disturbing and I'm about ready to leave over it.

[Jules A, MSN]

Do you go wake up the sitter? Do you catch flak for doing so? Does your Admin back you up? What became of the sitters who allowed these things to happen? Were the sitters asleep, resting their eyes, or in some other way inattentive and derelict in their duty?

Or did the patient just move too quickly for the alert, on-the-ball sitter to prevent trouble? That can certainly happen and is not always preventable.

Policy states that staff are to "continuously monitor" the client. The policy really should say clearly that there can be no closed eyes because the point could be argued that hearing is being employed to monitor. The aide's view is that the snoring patient can be monitored audibly. I say people can fake snoring., therefore, staff eyes need to be open. Closed eyes can lead to sleeping and how would anyone know that now the staff is asleep, even if he or she was awake a few minutes ago? And snorers don't necessarily snore all night, even when sleeping.

We also trade off frequently, leaving a sitter on 1:1 for no more than an hour at a time. We still get sleeping sitters. It is maddening and scary.

The thing is, nothing bad has ever happened at our place when sitters have slept. I almost wish something would. Not really, of course, but I bed policy enforcement would increase if it did.

The whole issue is very disturbing and I'm about ready to leave over it.

Sorry about that, I wasn't clear with my statement because I haven't personally "seen" a 1 on 1 go wrong. I should have said that it has happened at my hospital. The latest incident happened when the client was in his room and the tech was sitting in a chair in the doorway. I didn't hear that the tech was sleeping just not keeping the client in eye shot I think.

When I'm working with a client that is on constant observation I pretty much constantly observe the staff member also. If they are nodding I relieve them and send them outside, for coffee etc. We kind of know who can be counted on to do the job properly and who won't so as pathetic as it sounds I just won't schedule them for this duty. Sadly some days the staff is more challenging than the patients.