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Constant Observation (Adult and Pediatric) (14.40)

Constant Observation (Adult and Pediatric) (14.40) - Policies, Clinical, UWHC Clinical, Department Specific, Nursing Patient Care, Unit Operations

14.40




NURSING PATIENT CARE POLICY & PROCEDURE

I. PURPOSE

A. To provide constant observation by healthcare personnel to ensure safe, effective care for
patients.

II. POLICY

A. Accountability/Responsibility
1. The patient’s nurse and Care Team Leader are responsible for assessing a
patient's need for constant observation.
2. The patients’ nurse and Care Team Leader are responsible for overseeing
outside agency, UWHC Nursing Assistant (NA) and other staff who assist with
providing constant observation.
3. The patient’s nurse and Care Team Leader are responsible to discontinue the
intervention of constant observation when the patient no longer meets criteria
for constant observation.
B. Family Requests
1. A family request for a constant observation, where it has been determined
there is no clinical need, are reviewed and approved by the Nurse Manager.
a. Families may be referred to an agency with which UWHC holds a
contract to make their own arrangements for care.
b. In these instances, the family will be directly billed by the agency for
services.
III. PROCEDURE

A. Decision Making Process
1. The patient’s nurse assesses the patient to be at risk for injury and
identifies strategies to assist in alleviating causative factors and promoting
safety. These include:
a. Discussion with physician and other care providers on team to identify
underlying causes of behavior (e.g., pain, review of medications that may
increase confusion, electrolyte imbalance, reduced oxygenation,
dehydration, infection, encephalopathy, etc.).
b. Use of physical therapy and occupational therapy.



Effective Date:
September 18, 2015
☐ Administrative Manual
☐ Nursing Manual (Red)
☐ Other _______________
Policy : 14.40 AP
☒ Original
☐ Revision Page 1 of 4
Title: Constant Observation (Adult and
Pediatric)



c. Relocating the patient closer to nurses' station with door open whenever
patient is alone, if appropriate.
d. Use of equipment as indicated (e.g., bed exit alarm, low bed, pommel
chair cushion, floor mats).
e. Consideration of alternatives to restraints including alarms, distraction,
hiding tubes with clothing and arm stockings, and consideration of
gastrostomy tube in lieu of NG tube if patient cannot swallow or eat for
prolonged period.
f. Toileting every 2 hours.
g. Removing unneeded invasive devices.
h. Monitoring sleep-wake cycle. Consider non-pharmacological
interventions for sleep.
2. The need for constant observation for a patient with suicidal behaviors or
ideations should be determined by the primary provider with consultation to
psychiatry if needed (see UWHC Administrative Policy 10.10 – Suicide
Assessment and Prevention).
3. The RN will complete an assessment of the patient’s need for constant
observation. This assessment will be based on criteria to determine safety,
patient judgment, capabilities, etc. Appropriate nursing interventions should be
documented in the patient’s plan of care with specified outcomes and
evaluations. (Please refer to algorithm “Determining Level of Constant
Observation”
4. The patient’s nurse will discuss assessment and interventions with the Nurse
Manager and/or Clinical Nurse Specialist. These are high risk patients that may
warrant assessment and involvement of the Clinical Nurse Specialist. If the
need for constant observation is identified and agreed upon, a review of the
continued need will occur every 4 hours until other interventions can be
implemented or a change in the patient is affected.
5. At the Clinical Science Center
a. The Care Team Leader or designee will directly communicate the request
to the Nursing Resource Center. The request will include:
i. Reason for request and justification for use
ii. Nursing Order in the patient’s clinical record to request constant
observation evaluation
b. The unit Nurse Manager, Clinical Nurse Specialist, or the Care Team
Leader will assist in determining the appropriate type of constant
observation intervention based on criteria provided. Additionally, the
Nursing Resource Center will arrange for the appropriate method of
constant observation and notify the Nurse Manager or designee of the
availability of such resource.
c. The Nursing Resource Center will assign resources for constant
observation to the requesting unit based on prioritization of request.
Prioritization will be based on patient's clinical condition and need.



Assigned staff should be provided relief for two 15 minute and one 30-
minute meal break per 8-hour shift.
d. When the patient no longer requires constant observation, the Nurse
Manager or designee will communicate the change in plans to the
Nursing Resource Center. The Nursing Resource Center will re-assign
duties of the constant observation resource.
6. At The American Center
a. The RN will complete an assessment of the patient's need for constant
observation by a Patient Care Tech (PCT). The assessment will be based
on factors to determine safety, patient judgment, capabilities, etc.
Appropriate nursing interventions should be documented in the patient's
plan of care with specified outcomes and evaluation time frames. (Refer
to algorithm “Determining Level of Constant Observation”
b. The requesting nurse will review the need for a PSA with his/her Care
Team Leader (CTL) and Clinical Nurse Specialist (CNS), when
available.
c. The CTL will assign a PSA to the requesting RN. Prioritization will be
based on patient's clinical condition and need. Assigned PCT staff should
be provided relief for two 15 minute and one 30-minute meal break per
8-hour shift.
d. When the patient no longer requires constant observation, the CTL will
re-assign duties of the PCT.
B. Guidelines for Constant Observation Assignments
1. The patient’s nurse will communicate patient care needs and or unit specific
responsibilities to the staff providing constant observation at the beginning of
the shift. Thereafter, communication with staff providing constant observation
will be ongoing throughout the shift and will be based on patient acuity and
complexity of care.
2. The staff providing constant observation will document patient care and
observations as appropriate according to the position description.
3. The staff providing constant observation will remain with the patient or at the
video monitor station until relieved by unit staff. When monitoring one patient,
the observer will keep the patient in view at all times. When monitoring more
than one patient, notify unit staff of the need to leave either patient in the event
of any emergent situations.
4. Patients requiring constant observation for suicide precautions require one-to-
one constant observation.
5. The staff providing constant observation will not remove patient restraints
without the approval of the patient’s nurse.
6. The staff providing constant observation will communicate and engage with
the patient throughout the shift, and will assist with reorientation of the patient.
7. The staff providing constant observation will report patient changes to the
patient’s nurse on an ongoing basis, and immediately if the change is



significant. The patient’s nurse will provide the observer with guidance as to
what constitutes significant change for the assigned patient.
8. The staff providing constant observation will give a change of shift report to
the patient’s nurse and to the oncoming constant observer (i.e., Patient Safety
Attendant (PSA) or Video Monitor Technician).
9. The staff providing constant observation is to be focused on promoting patient
comfort and safety and meeting patient care needs.
C. Authorization of Clock In/Clock Out Times
1. Staff providing constant observation are expected to clock in as scheduled at
the start of the shift, and to clock out as scheduled at the end of the shift using
the observer code.

IV. UWHC CROSS REFERENCES

A. UWHC Administrative Policy 10.10 - Suicide Assessment and Prevention
B. UWHC Administrative Policy 4.15 – Videotape Recording and Patient Photographs
C. Criteria for Constant Observation Evaluation
D. Determining Level of Constant Observation Workflow

V. REVIEWED BY

A. Clinical Nurse Specialist, General Medicine and Geriatrics
B. Clinical Nurse Specialist, Geriatrics
C. Clinical Nurse Specialist, General Medicine and Family Practice & Forensics
D. Clinical Nurse Specialist, Heart and Vascular Care, Progressive Care
E. Clinical Nurse Specialist, Rehabilitation
F. Clinical Nurse Specialist, Transplant and General Surgery
G. Clinical Nurse Specialist, Safety
H. Director, Nursing Operations Support
I. Director, Nursing Quality and Safety
J. Director, Professional Services, UW Health at The American Center
K. Nursing Patient Care Policy and Procedure Committee, September 2015

VI. SIGNED BY
Beth Houlahan, DNP, RN, CENP
Senior Vice President Patient Care Services, Chief Nursing Officer