15 minute checks...worth using??

There are documented checks every 15 minutes, at least the first hour for any type or restraint. Even drug and soft restraint..............per JCAHO policies. And this is just for regular types of units, med/surg or critical care, etc. Even infants.............

Hi -- I am a child psych CS with lots of experience on inpatient adol psych units, both as a staff nurse and CS, so I understand all your very legitimate concerns.

I am enough of an old-timer that I remember back when everyone in psych understood that "15 minute checks" is a short "nickname" for RANDOM CHECKS NO MORE THAN 15 MINUTES APART. You are right that 15" is certainly more than enough time to kill oneself, let alone just hurt oneself. 15" checks are useless if all they do is allow a potentially dangerous patient to figure out (quickly, usually) that he or she can count on 15 minutes of uninterrupted peace and quiet once staff has checked on him or her ...

"15" checks" used to mean that you checked on the person at random intervals but no more than 15 minutes apart. That way, the patient never knows, if you just checked on him or her, whether it will be quite a while before you check again or whether you'll be popping in any second now ... THAT is how "15" checks" help keep a person safe, not the "every quarter hour on the quarter hour" approach that most places now use.

I worked for several years as a mental health investigator/inspector/regulator for my state, and I can't tell you how many deaths on psych units I investigated, all patients who were on 15" checks when they killed themselves. The staff were always quite confident that they had done all they could have done to keep the patient safe, because, by golly, they had checked on the patient EVERY 15 MINUTES, regular as clockwork, come heck or high water. I'm not condemning or criticizing any specific staff members; they were following hospital policy and doing what their bosses had told them to. But, as I said at the beginning of my rant, I remember when when we all understood what "15" checks" was supposed to mean ...

I hate to sound like an old battleaxe/old fogey (which I now am, I guess), but this issue has become one of my pet peeves, esp. since I've had first-hand experience with all the deaths I mentioned above. Not only are the patients dead in those situations, but family members are bereaved, unit staff are traumatized by the experience, and (not to put too fine a point on it,) it makes the hospital/unit look bad to the public. Plus, in my experience, the investigations triggered by the deaths often ended up with the hospital in significant trouble with the state or the Feds, which is always unpleasant and unfortunate for everyone.

As for documentation, if you're doing the randomized interval checks you check on the person more frequently than q 15" and that is easy to do in the normal course of coming and going on the unit. I am accustomed to not necessarily documenting right when I did every check, but I certainly wouldn't go more than a few checks before catching up the paperwork.

Many facilities assign a single staff person (typically, a tech rather than a nurse) to be responsible for doing all the safety checks, but some leave it to the staff person assigned to each patient (who is on checks) -- and how many patients are on checks may determine which approach makes more sense. Yes, if the individual staff are doing the checks on their assigned patients, that is considered a heavier patient care load and the assignments are adjusted to reflect that ... I'm accustomed to the charge nurse being responsible for assigning the checks and following up to be sure they have been done and documented. If one person is going to be doing all the checks, often that is broken up during the shift, so that (e.g.,) Tech A does the checks for the first two hours of the shift, then Tech B does them for two hours, etc. Of course, the charge nurse also has to figure in coverage for staff meal breaks, etc.

I've been saying for years (and some colleagues have been grinding their teeth and rolling their eyes when I say it), for what it costs to be on a psych unit, THE LEAST we can do for people is keep them safe ... It's really not that much more effort than all the stuff that is done on psych units in the name of safety that really DOESN'T do anything to help keep people safe ...

I apologize for the lengthy rant :chuckle -- hang in there ...

I, too, remember the days when death occured in psychiatric hospitals.

What's with "the days when ..."?? People are dying on psych units every day (somewhere ...) When I say that I investigated deaths, I'm talking about within the last few months, not the dark ages.