ALL ABOUT
SAFETY SITTERS
Safety Sitter Education
Task Force
September 30, 2012
Objectives
The learner will be able to…
1. Identify what actions should be taken prior
to requesting a safety sitter
2. State how to request a safety sitter
3. Familiarize and utilize strategies to keep
patient safe
Safety Sitters

Definition: A safety sitter is an individual trained to
observe and sit with a patient to keep them safe

A safety sitter may be an Observation Assistant (OA)
or a Patient Care Technician (PCT).
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PCT safety sitters should perform functions of a PCT
for the patient they are sitting for

For the purposes of this training, we are not referring
to sitters used for :
– suicide precautions or
– behavioral restraints in the inpatient setting
Purpose of Safety Sitter Education

To provide strategies in addressing the
increasing need of safety sitters

To inform staff of available resources in
addressing the safety needs of patients

To efficiently use our sitter resources
Safety Sitter Algorithm

A Safety Sitter Algorithm has been created
as a reference to guide staff in identifying
patients needing safety sitters

The algorithm, policy and resources are
available on the intranet site under:
Contents  Safety Sitter

The following slides will highlight key points
in the algorithm
Safety Sitter Algorithm

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The initial steps in using the algorithm involve
determining patient’s behavior.
The nurse will:
~ Assess the patient and attempt to identify the cause
of the behavior
~ Address the cause with an appropriate intervention
~ Notify the Administrative Supervisor if suggested
strategies are ineffective
Safety Sitter Algorithm
Addressing Patient Condition
There IS an
improvement in
patient’s behavior
This is NO
improvement in
patient’s behavior
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Collaborate with the
doctor and charge nurse
This may involve
additional diagnostic
testing, a MET or even a
transfer to a more
appropriate unit
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–
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Initiate appropriate
strategies to keep patient
safe
Use your resources
Consult with families to
see if they can be of
assistance
Offer private sitters if
needed
Strategies to Keep Patient Safe
Rounding
Music Therapy
Delirium Protocol
Animal Assisted Therapy
Fall Prevention Protocol
Sleep Enhancement
Pain Management Protocol
Consult with Geriatric APN
Patient Activity Progression
Protocol
Consult with Mental Health Staff
Bladder Scan Protocol
Ask Family to stay
Use of Activity/Book Carts
Offer use of Agency sitters
Use of Thermo-flect Blanket
Use Unit Resources
Use of Delirium Protocol

The Delirium Protocol is an excellent resource to assess
patients who may be developing delirium. It should be used for:
–
–
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Assessing patients at risk for development of delirium
Identifying possible precipitating factors for development of
delirium and possible nursing actions
Identifying appropriate interventions for prevention/treatment of
delirium
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Comfort and Spirituality
Meals and hydration
Mobility
Communication and orientation
Relaxation and Sleep
Medication Management
Highlights of Delirium Protocol
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Encourage family participation
Offer religious objects and reading
materials
Prevent or treat constipation
and/or urinary retention
Offer toileting every 2-3 hours
Provide companion and assist
with feeding and meals
Use relaxation activities- activity
cart, breathing techniques, music,
hand massage, Sleep promotion,
non-medication alternativesmusic
Orient to the environment- use
reminiscence, life review &
conversation. Review “Who Am I”
Use of stuff animals for the elderly
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Early mobilization and regular
exercise as medically allowed
Pain assessment
Range of motion exercises 3
times daily for bedrest patients
Allow patient participation
Ensure hearing aides and
glasses are used and in working
order. Offer hearing enhancer or
magnifiers.
Consult with physician about
appropriate medication
management
Consult with pharmacy regarding
medication interaction
Consult with Geriatric APN –
Julia Knight
Highlights of Protocols
Rounding
& Pain Management
Culture of caring - 4 Ps
 Pain- Assess pain and
medicate PRN
 Potty- Offer toileting
 Position patient every
2 hours
 Presence
Fall
Prevention
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Assess patient risk
Identify patient at risk
Use of yellow socks
Call light accessible
Bed alarm as
necessary
Highlights of Protocols
CIWA/DT
CIWA/ DT Patients
Patients
Purpose: provide direction
and medication
management of patient in
DTs
 Highlights
~Medicate every 2 hours
~Follow CIWA protocol

Animal Assisted
Therapy
Purpose: provide
companionship and
diversion for patients
 Highlights
~ call x.
to request for
AAT visit
~Follow AAT guideline on
what is appropriate
~ no visit with isolation
patients

Highlights of Protocols
Sleep Enhancement
Protocols
Purpose: assist patients in
promoting relaxation
conducive to sleep
 Highlights
~ Use of music
~ Promote a quiet
atmosphere
~ Medication, if appropriate
~ Bath/Backrub at night
~ Warm milk

Patient Activity
Progression Protocols
Purpose: Increase activity
to avoid boredom and
relieve restlessness
 Highlights
~ ambulate when appropriate,
if restless
~ restless in bed- get patient
up to a chair
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Highlights of Resources
Use of Care /Book
Carts
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Purpose: Provide diversion
activities to occupy
patients time
Locations- Each unit has
one. refer to each unit for
location
Use of Thermo-flect
Blanket

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Purpose:Provide warmth
and comfort
Follow thermoflect policy
Role of Families

Families are an untapped resource

Families can be brought in to assist in
keeping their loved one safe
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–
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Families are familiar with patient routines at home and may
know strategies to keep patient calm and safe
Familiar voice or face can be calming to patients
Families can hire outside assistance and
use an Agency Sitter (List on the intranet)
Unit Resources
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Unit Charge Nurse
Unit Manager
Unit CNS/Clinical Educator
Unit GRN (Geriatric Resource Nurse or Gero Certified RNs)
Geriatric APN (Julia Knight x. )
Consult with Pharmacy (x.
)
Consult with Mental Health (x.
)
NICHE Module
Safety Sitter Intranet Site (Intranet->Content-> Safety Sitter
education)
Administrative Supervisors (x7933)
Safety Sitter Education Task Force Members
Role of Administrative Supervisor

When the Administrative Supervisor (AS)
is called, they will consistently ask:
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Patient behavior
Intervention Attempted
Family available
How will you keep patient safe if sitter is not available
The AS can help determine if an NCH
sitter is available
Safety Sitter IS Available

If a sitter is provided, the unit will have
give sitter report:
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Nurse must give sitter handoff sheet to sitter and give report
to sitter on details outlined on the sitter handoff sheet
Identify PCT resource for sitter for sitter breaks and other
issues
Provide extension number for charge nurse and patient’s
nurse to sitter
Round on patient every hour

Sitter usage needs to be reassessed every 2
hours
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Notify supervisor of changes in sitter need
Safety Sitter IS NOT Available
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If a sitter is not available, the unit will be
asked to:
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Ask family to stay with patient
Assign own unit PCT or rotate watching patient.
Consider strategies & diversion activities
Consider Bed alarm, mitts and other device
Consider use of restraints as last alternative
Scripting Guide for Staff
Conclusion
There are many ways to keep our patients safe
and NCH has developed a comprehensive list
of resources to be used by bedside clinicians.
It is key for staff to be familiar and understand
the strategies and resources available for the
complexities of keeping patients safe
Working together can make a difference
QUESTIONS
Contact your leadership
or
Safety Sitter Education Task Force
Claudette
Johnson
Mary
Webb
Lori Balek
Shime
Herrera
Zita Nadal
Denise
Krantz
Thank you for your commitment to improve patient care by
effectively utilizing staff,
maximizing use of our resource
and more importantly, keeping our patients safe.
10.21.12