Date of Graduation

Winter 12-15-2023

Document Access

Project/Capstone - Global access

Degree Name

Master of Science in Nursing (MSN)


School of Nursing and Health Professions


Kaiser cohort MSN capstone

First Advisor

Dr. Liesel Buchner



Problem: The facility highly utilized sitters or care companions, negatively impacting the staffing plan, budget, and productivity. An average of 56 hours of care companions were used daily. This greatly exceeded the budget of 33 hours a day. Reassigning Patient Care Technicians (PCT) as care companions resulted in inadequate nurse support for patient care and increased cost for additional staffing needs. Despite this, the fall rate remained higher than the target.

Context: The patient population is mainly 65 years old and above, sometimes with confusion, dementia, delirium, and at high risk for falls and elopement. The culture included promptly deploying care companions to keep these patients safe without following a standardized algorithm.

Interventions: The project intervention was formulating and implementing a standardized care companion decisional algorithm to reduce care companion utilization and simplify the workflow. Measures: The outcome measure was the reduction of care companion utilization by 20%. The process measures included education/training, using the decisional algorithm forms, and implementing safety alternatives to prevent care companions. The balancing measure was the number of falls for patients for whom a care companion was requested but not provided due to effective alternatives.

Results: The preliminary results demonstrated an improvement in the workflow of requesting care companions, reduction of care companion hours, consistent use of the request form, and no fall occurrence for patients with whom care companions were requested but not provided.

Conclusion: Care companion hours could be reduced without increasing the number of falls or compromising patient safety. Many alternatives can be implemented to prevent its use.