Observation Policy

[StuPer]

Hello Everyone,

I have been asked to look around the Net and speak to online forums to see if anyone would be willing to share their acute unit observation policy. Our unit is starting an observation area for patients who are at increased risk, and I would be eternally grateful for anyone who can assist us in getting a solid and competent policy in place. Local and state policies are not definative or clear, so we're going further afield for help.

regards StuPer

[Nurse Ratched, RN]

We have monitored rooms with cameras on at all times in our acute unit. Anyone deemed that great of a risk would likely have a 1:1 assigned to him/her, altho it's unusual to have a pt requiring closer surveillance than our 15 minute checks and being constantly in visual contact with staff. All pts in our acute unit are given specially colored scrube to wear (distinguishing from staff just in case the obvious psychosis doesn't .)

[lil'nurse]

Yep we do the same thing, we change our pt. into scrubs as soon as they come on the unit. We have to have an MD order to give pt's back their clothes. We had a suicide on our unit a little while ago and it really changed our safety measures. We have a person whose only duty is to walk through and do checks. Those at high risk for suicide or behavioral issues are on 1:1 or 5 min checks and in a camera room.

[StuPer]

Thx for the replies, I guess that your working in an environment that represents a higher risk than here, as we would'nt put patients in scrubs normally, in fact the only time I've observed something similar is when a patient was put in loose underwear while in seclusion because of the level of risk.

I can understand the rational for scrubs though as you know they are safe, dont provide the opportunity for concealment that normal clothing does.

On the issue of clothing though, do patients generally wear nightware or scrubs in your units? Here and in most facilities I know of in Australia patients generally wear their own clothing while admitted.

regards StuPer

[Frankcah]

I work in a secure assessment & treatment evironment. Patients wear their own clothes. We have 4 levels of observation

Level1 - Baseline obs - check whereabouts every 30 mins (basic)

Level2 - Enhanced obs - check whereabouts once at a random time within a 30 min period

Level3 - Within eyesight of staff

Level4 - Within arms length of staff

We may have to modify parts of levels to suit the patients need by using care plans.

Patients are at risk of harming themselves or others.

Anyone on level3/4 will have an extra member of staff assigned to them to enable the observations. Observations are recorded on 15 min basis.

[Nurse Ratched, RN]

We have two levels:

Everyone on psych is on 15 minute checks.

If the pt is one:one, policy states the pt must be within arms length of the observing staff member at all times.

We have three different units. The most acute unit (from a psych standpoint) is the one where our pt's wear scrubs - also for bedtime. On the other two, regular clothing may be worn (no laces/strings on clothing if on suicide precautions.) If someone is on elopement precautions, the nurse has the option of removing shoes and requiring scrubs.