Monitoring of patients

[medsurgrnco, BSN, RN]

Our facility is considering changing how patients are monitored by MHT. I am now involved in part of the training for MHT and am making suggestions to management on how to improve care of our patients. Our patients are free to roam the facility 24/7, and have both day and sleep wings which are far apart. We have different observation levels, with staff assigned accordingly rather than patients being restricted. They have scheduled smoke breaks when pts are typically awake and later breaks occur upon pt request 24/7. If the milieu or a patient is of high concern, this setup changes based on nursing judgment (altho some MHT don't understand this and problems have occurred). Management really wants to reduce the use of seclusion, restraint, court-ordered meds, and emergency meds and we've been able to do that with this setup.

I would like to know how patients are monitored at other facilities and what documentation is done to show that patients are being monitored by MHT. I also would like to know what expectations pose difficulties for your MHT and what makes their jobs easier.

I would greatly appreciate any input and PM is available for anyone that wants more anonymity. Trying to remain anonymous, so requests for more detailed info about our facility will be available thru PM.

Thanks so much in advance!

[Murse3]

On the16 bed. locked unit I work on, the MHT, or BHT as we call them, performs a safety check every 15 minutes on all pts regardless if they are a new admit or are going home that day which is recorded on a paper with places to show the pt's location and behavior at that time of the check. Obviously, "high concern" pt's are placed on continual observation or line of sight until they deescalate and they still have the 15 minute check sheet filled out by staff. All safety check sheets are placed in the chart once filled for the day and a new one is started. One thing that I like is that our unit really stresses safety on the unit and everyone, nurses and techs, put safety checks as priority number 1. Hope this helps.

[medsurgrnco, BSN, RN]

Murse3, this is the type of information I was looking for. I would like to know how many pts the BHT is responsible for, and needs to document on every 15 min. Are these pts free to roam or do they stay in the same area. Are the BHTs able to do this level of observation as expected while doing other assigned tasks and helping with pt needs/requests? Would you explain more how continual observation or line of sight is done? Sounds like you have adequate staff to do this. Could you be specific in terms of numbers? What happens if scheduled staff call off, decide to leave unexpectedly, or for other reasons you need more staff than are there to ensure pt safety? How do you handle breaks? I consider safety #1, but some MHT don't get it, and management doesn't always seem to get my concerns either. Thanks so much!