How is this handled at your facility?

[qaqueen]

Our policy requires that a SI pt have a direct observer until cleared by Psych. I would like to know how a couple of issues with SI patients is handled at other hospitals.

What if the SI pt is intubated and sedated? Observer or no?

What if the pt is trached, not sedated, not restrained but still intubated? Observer or no?

Does your facility require that a direct observer is ordered by MD?

Our policy does not currently address intubated SI patients, whether sedated or awake. Curious about how the rest of the world deals with this.

Thanks in advance.

[MunoRN, RN]

We don't use a 1:1 sitter for restrained and sedated vented patients who are here for either known or suspected suicide attempt. Once they get extubated, they are considered 'high risk' until their suicide risk level is downgraded by the SW or LIMHP, only 'high risk' gets a 1:1 sitter which in this situation is called a "safety attendant".

I've worked at facilities that have attempted to bend the (state) rules a bit, claiming that just being in the ICU was sufficient monitoring to not require a 1:1 observation, or that patients could be considered low risk until officially designated high risk, or having the patient promise not to try and kill themselves while their here and call that good enough and remove the close observation.

The MD plays no role in determining if a 1:1 is required. I'm not sure what you mean by "trached...but still intubated".

[BedsideNurse]

If a pt demonstrates SI or comes in after SA they are sectioned and automatic 1:1. At our hospital the MD has to write the 1:1 order. The only way these patients don't get a 1:1 sitter before they are cleared by psych is if they are both vented and sedated.

[MunoRN, RN]

On ‎4‎/‎29‎/‎2019 at 9:11 PM, BedsideNurse said:

If a pt demonstrates SI or comes in after SA they are sectioned and automatic 1:1. At our hospital the MD has to write the 1:1 order. The only way these patients don't get a 1:1 sitter before they are cleared by psych is if they are both vented and sedated.

So what happens if the MD doesn't feel like ordering a 1:1 sitter?

[qaqueen]

Thank you. We have a policy that does not require a MD order for 1:1, however, when pt is intubated and sedated, conventional wisdom at my facility is to dc observation. The odd thing (to me) is that if the pt gets trached, but is still intubated (no sedation) no observer is required.

[qaqueen]

On 4/28/2019 at 5:38 PM, MunoRN said:

We don't use a 1:1 sitter for restrained and sedated vented patients who are here for either known or suspected suicide attempt. Once they get extubated, they are considered 'high risk' until their suicide risk level is downgraded by the SW or LIMHP, only 'high risk' gets a 1:1 sitter which in this situation is called a "safety attendant".

I've worked at facilities that have attempted to bend the (state) rules a bit, claiming that just being in the ICU was sufficient monitoring to not require a 1:1 observation, or that patients could be considered low risk until officially designated high risk, or having the patient promise not to try and kill themselves while their here and call that good enough and remove the close observation.

The MD plays no role in determining if a 1:1 is required. I'm not sure what you mean by "trached...but still intubated".

A pt with a trach that is still vented.

[Delia37, MSN]

I work in Southern Ca, in the Orange County area. Around here, a 1:1 suicide watch sitter is required (even if the pt is sedated/intubated) until cleared by psych. At my current facility, we do not require a MD order for 1:1.