How to Create a Successful Patient Watch Program

Appropriate staffing, training, collaboration and contract language are just some of the steps that will ensure the safety of patients, clinicians and security officers.

One highly specialized area that is equally a function of hospital operations and security is patient watches. With the continual rise of drug and alcohol related emergency department (ED) visits and the reduction of behavioral health facilities, is it any wonder that there is an increasing need for patient watches? Every healthcare leader should be asking if the right staffing is in place for these watches, and if officers and staff are trained to effectively conduct them.

What Is a Patient Watch?
In developing an effective patient watch program, it is imperative to first review how it is defined. A patient watch is not to be confused with a “sitter program” where a healthcare attendant watches a patient who is elderly, disabled or impaired and may be at risk of falling or other non-violent risks. A patient watch is implemented to monitor a patient for the purpose of protecting him or her and others from violent or aggressive behavior. The patient must be identified, per the laws of the individual state, as a threat to themselves or others and placed in an involuntary patient status by the appropriate authority, which could be law enforcement or clinical staff.

Patient watches encompass both committed and non-committed patients. A non-committed patient watch describes a patient who the hospital feels is a danger but who has not yet been formally evaluated by a psychiatrist. The patient under a non-committed patient watch is under no legal obligation to remain on the premises and could voluntarily leave at any time, even against medical advice.

How patient watches are conducted varies across institutions, and they are largely dependent on the layout of the hospital. Some maintain a specific seclusion room, with visibility through glass doors and a camera system, which could be equipped to house up to several patients simultaneously. A security officer is able to monitor the CCTV feed and respond if a problem arises. It is important that additional officers and/or medical staff are immediately available to assist in this situation.

Other facilities may utilize standard exam rooms with a patient watch security officer assigned there when needed. The location of patient watches is typically designated to ED and behavioral health units, and not med-surg units, unless properly staffed to do so.

Correct Staffing is Crucial to Success
Well-trained security officers are an excellent resource for patient watches. While the responsibility for the patient watch resides with the medical team, which must respond in the event of an incident, the support of security officers is incredibly valuable. The medical and security staff must collaborate as the clinical demands of medical staff often prohibit them from being assigned solely to conduct patient watches.

RELATED: Navigating the Labyrinth of Healthcare Security Regulations and Best Practices

Will a security officer be pulled off their regular post to be assigned to patient watch? Will someone be assigned from outside the organization? Are dedicated patient watch security officers assigned to each shift? If a patient is aggressive and a security officer is responding, back-up security needs to be close at hand. Also, because an aggressive patient is susceptible to adverse health developments, it’s critical that the medical staff is prepared to respond quickly.

There must be a careful balance of staff to ensure that an increased number of patient watches don’t compromise security elsewhere in the facility and vice versa. As a result, the patient watch program must be viewed as a formal component of the security program and not an add-on assignment. This specialized staffing can be addressed through permanently scheduled staff; flex officers who are cross-trained for assignments in more than one facility within a health system; and a combination of onsite and on-call security officers.

The right staffing model for each facility should be established based on the facility’s individual needs. Staffing considerations must be supported though policies, contracts, training and supervision. Clearly defined expectations and support are critical for success.

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