Reexamining Overuse of Frequent Observation for New Admissions on Psychiatric Units to Increase Nurse/Patient Engagement

Date of Graduation

Winter 12-14-2018

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School of Nursing and Health Professions

First Advisor

Mary Seed


People in California who suffer from mental health conditions are often admitted involuntarily to hospitals on 72 hour psychiatric evaluation holds if they are deemed imminently dangerous to themselves, or others, or are gravely disabled. Observational patient safety checks are performed and based on patient acuity and hospital standards. Variations exist among different clinical settings with regard to best practices and the patient subpopulations that may warrant less frequent safety checks. Nurses experience different levels of satisfaction with regard to frequency of safety checks because there is no national consensus on which subsets of patients may require them. A senior inpatient psychiatric nurse and clinical nurse leader (CNL) student led a practice improvement and education project over three months to decrease overuse of frequent observation in subsets of appropriate patients with the aim to increase nurse/patient engagement. Initial results indicated an inconsistent level of nurse’s readiness to change existing conventions, but fortunately, the findings also reflected a willingness to refocus their workflows on continuous improvement and a meaningful nurse/patient engagement that is needed for recovery.

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