Decline Companion Initial with airSlate SignNow

Decline companion initial

my name is katherine skoronski and i'm a clinical nurse specialist with the cleveland clinic hospital in cleveland ohio i'm part of a team who developed an innovative approach to prevent falls and decrease patient companion use for high-risk patients on an internal medicine unit in collaboration with nursing leadership psychiatry and social work we built a four bed close observation unit cou for short within an existing 32 bed internal medicine unit as a result even though patients in the cou were more likely to have neurologic and psychiatric conditions and be on average eight years older than patients who remain on the internal medicine unit the cou fall rate was similar to that of the internal medicine unit and use of patient companions decreased traditionally interventions to minimize falls were focused on increased observation for example use of volunteers to observe patients behaviors passive alarms diversional activities and placing patients in public areas such as the nurses station however it may be difficult to implement some of these interventions associated with close monitoring patient companions were commonly used for patients who interfered with medical therapy pulled at lines were unable to follow directions wandered displayed delirium or were at risk to attempt suicide however patient companion use is a costly falls prevention strategy with minimal evidence to support its effectiveness the four-bed cou was created by opening a wall between two semi-private patient rooms glass partitions and two nursing workstations were placed in the center to increase visibility of patients and allow for quick access to meet patient needs staff nurses gave input on the physical layout of the unit what equipment should be included and they self-schedule to staff the cou the cou is staffed with one rn and one unlicensed non-certified clinical technician per shift this is consistent with the nurse to patient ratio on the rest of the 32 bed unit but an increase from the typical ratio of unlicensed assistive personnel in our sample cou patients tended to be older and had higher rates of neurologic or psychologic disorders despite safety risks to older patients and those with neurologic and psychiatric conditions there were no differences in fall rates between the units we compared the use of patient companions in the internal medicine unit 61 days before and 61 days after the cou opened and found a four-fold drop in patient companion hours in 61 days prior to the cou opening there were 480 shifts and 3840 hours used in the 61 days after opening the cou the numbers decreased to 115 shifts and 920 hours of patient companion care used the cou did not use any patient companions during the time period representing cost savings for the department and also optimal assignment of patients to the cou when patients are agitated are at a higher risk of falls or demonstrate inability to follow directions to maintain personal safety they require an environment that maintains safety and supports optimal quality of care a cou...