Implementation of a nurse-driven algorithm for safety companion usage: a pilot study

Abstract

Safety companions, also known as sitters, are commonly placed in a 1:1 setting with patients in hospital settings to maintain their safety. These patients include (a) those that are suicidal, confused, delirious, or violent; (b) those with psychiatric issues; (c) those with behaviors that interfere with their medical treatment; and (d) those experiencing behavioral problems associated with substance abuse. However, several problems exist with the use of safety companions, such as cost, inconsistent evidence supporting their effectiveness, and lack of evidence-based guidelines for their use. The primary aim of this pilot study was to assist staff RNs on a 39-bed inpatient hospital unit in using more discernment in the use and management of safety companions. Based on the needs of key stakeholders at the pilot site and a thorough review of the literature, a nurse-driven, evidence-based algorithm for safety companion usage was developed and implemented over four months to meet this aim. In addition, the project investigated the issues surrounding safety companion use and compared these issues to those experienced at the pilot site. Five online surveys targeting different groups of stakeholders were used pre- and post-implementation of the algorithm to assess their perceptions of the algorithm and its effect on the management of safety companion usage. The success of the algorithm was determined by the level of nursing satisfaction with the algorithm and whether it was helpful to assess their patients for a safety companion. The primary aim of the project was successfully met, with all participating team leaders finding the algorithm to be 'somewhat' to 'very effective' in helping staff RNs in being more discerning with the use and management of safety companions. Most of the unit's participating team leaders (87.5%) were satisfied with the algorithm, and all of the participating staff nurses found the algorithm to be 'somewhat helpful' or 'very helpful.' Implications for improvement included room for additional education and training for safety companions, improved staffing and support when using the algorithm, and issues surrounding patient safety.