Qualitative Improvement Project Aimed to Develop 1:1 Patient Monitoring Guidelines in the form of a Flowchart for Inpatients Diagnosed with Components of Disorganized Behaviors

Qualitative Improvement Project Aimed to Develop 1:1 Patient Monitoring Guidelines in the form of a Flowchart for Inpatients Diagnosed with Components of Disorganized Behaviors

Patient Monitoring Guidelines in the form of a Flowchart for Inpatients Diagnosed with Components of Disorganized Behaviors. Mental health is a state of successful performance of mental function, resulting in productive activities, fulfilling relationships with other people, and the ability to adapt to change and to cope with challenges (Healthy people, 2020). Mental health is essential to personal wellbeing, family, and interpersonal relationships as well as the ability to contribute to community or society (Healthy people, 2020). Mental health inpatient hospitalizations have been on the rise with the increase in societal challenges reflected by an increase in social disparities, racial and ethical diversities, and this nations response to COVID that has brought uncertainties to all social groups. People with behavioral and psychotic experiences, increasing depression, drug or alcohol addiction are in disparate need of a safe and structured environment such as an inpatient mental health unit, to stabilize (Magoon et al., 2020). Due to the severity of mental health symptoms, which range from being suicidal, aggressive, disoriented or confused, intrusive, mental health patients are often placed on a 1:1 observation or sitters. During their stay in the hospital, 13–16% of psychiatric inpatients will be placed on continuous observation, which includes a staff member continuously remaining within eyesight of a patient at all times (Barnicot et al., 2017). This intervention is frequently utilized to monitor patient symptoms with a desired outcome of maintaining safety for the patient and the unit. This proposal will address a quality improvement project related to creating awareness on the financial and staffing impact of a 1:1 sitter utilization within the inpatient mental health units. This proposal will also seek to develop guidelines/tools that will be used to make sure patients on a 1:1 sitter are timely reassessed to facilitate the discontinuation of this intervention as appropriate. The 5 1:1 SITTER IN INPATIENT MENTAL HEALTH UNITS expected outcome of these guidelines is to reduce the time patients are spent on 1:1 sitter, which will directly affect the facility financial and staffing resources. Problem Statement and Project Significance and background Staff nurses in inpatient acute mental health unit, one of the mental health units at a Hospital Setting, are not currently using standard guidelines/tools that is tailored towards reassessing patients on 1:1 sitters to facilitate the discontinuation of this intervention. The focus of the project is to develop a patient monitoring guideline and algorithm tool. Patient safety and quality improvement are intertwined. Quality improvement is gradually gaining grounds in the health care field and most improvement projects begin with staff/patient asking questions or bringing up an idea on how a situation/system can be better implemented. The notion that 1:1 sitter improves quality of care and increase unit safety can be challenged using developed guidelines as well as training and standardized decision-making tools (Wood et al., 2018). With the increase in sitter use in hospitals many associated challenges and burdens have come into play. Quality improvement projects have been carried out to determine the most appropriate process to assure efficient resource utilization and safe patient outcomes. One of such projects developed to reduce use of 1:1 sitter, was carried out by a group of proactive behavioral health managers in a general hospital using a quality improvement project. The project shows the average monthly cost of observers was reduced by 33%, and length of stay was reduced 15% (Pinkhasov, et al., 2018). The quality project developed care protocols for 1:1 sitter that resulted in improvement in quality, reduction in cost, and enhanced behavioral health integration in the general hospital. With regards to Telesitters, it was found out that Telesitters also stand to reduce factors contributing to burnout of frontline patient care staff, mainly nurses, hospital aides, and healthcare security. Telesitters are staff who watched patients place on 6 1:1 SITTER IN INPATIENT MENTAL HEALTH UNITS 1:1 monitoring using a device such as a computer. In a 2014 national survey of healthcare safety professionals, 59.2% felt the use of Telesitters for 1:1 observation would be useful (Krasniansky, 2020). Mental disorders are health conditions that are characterized by alterations in thinking, mood, and/or behavior that are associated with distress and/or impaired functioning (Healthy people, 2020). Mental disorders contribute to a host of problems. These problems also eventually influence individual wellbeing, which can contribute to challenges within families, healthcare facilities, communities, creating a domino effect as these challenges evolve into both social and global issues. The number of patients placed on a 1:1 sitter, especially in inpatient psychiatry