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.
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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.
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.
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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.
Create Appropriate Policies and Procedures
Hospitals are increasingly seeing the need to create patient watch policies and procedures that include a use-of-force policy. The absence of a policy can result in poor training standards and confusion among medical and security teams, exposing the organization to risk.
The use-of-force policy should provide guidance on the level of force that is appropriate for various situations as well as the factors that security officers and hospital staff should consider when faced with a use-of-force situation. It’s also important to have a restraint and seclusion policy that identifies which member of the medical staff has the authority to order restraints and seclusion at the facility. It should also identify procedures for related instructor-led, hands-on training for both hospital and security staff.
Adopt Contractual Language
Hospitals should also consider adopting standardized contractual requirements for their patient watch staff, which include specific training requirements, job descriptions, hiring requirements, procedures and uniform and equipment detail. Patient watch needs to be identified within the scope of the security contract to include a clear and correct definition of the term “patient watch.”
Contracts should also state that the hospital has the overall responsibility for the patients and patient watch practices and security officers will follow the direction of clinical staff in the application of controlled restraints; that security officers will engage to an extent appropriate to protect the safety of staff without placing the officers at risk; and that the hospital has the responsibility of providing appropriate clinical staff de-escalation training as required by the Centers of Medicare & Medicaid Services (CMS).
Do Officers Have the Right Equipment?
The safety of security officers necessitates a careful review of appropriate personal protective equipment for patient watch duty. Security officers should have gloves, face shields and wear long sleeves to help avoid bites from patients. When necessary, patient spit masks should be available to prevent patients from spitting on security and medical personnel.
Collaboration Is Essential
The logistical challenge of patient watches necessitates a partnership between clinical staff and security personnel. For example, a patient may require sedation from the clinical staff and de-escalation verbal commands by the security officer. A team approach and overall understanding that everyone involved is working toward the same goal also leads to greater success. Even with the support of a dedicated security team, patient watches remain a patient-centric process, requiring the ongoing attention and supervision of the medical team.
Train Your Officers
Patient watch security officer training is extensive and includes hospital-specific training, safety training, de-escalation techniques, basic life support or CPR/AED/First Aid training, and customer service training. Security officers are trained that physical restraint is a last resort for any patient. De-escalation techniques stress the importance of advance planning and empathetic listening.
The goal of patient watch security officers is to prevent the need for physical intervention through observation and de-escalation techniques.
Contractors Must Have Experience
The right contract security provider has extensive healthcare facility expertise, and experience working with accrediting bodies and agencies including the Occupational Safety and Health Administration (OSHA), The Joint Commission, Centers for Medicare & Medicaid Services (CMS), and DNV as well as state and local regulators. In addition, active involvement in healthcare associations including the International Association for Healthcare Security and Safety (IAHSS), the American College of Healthcare Executives (ACHE) and the American Society for Healthcare Engineering (ASHE) is vital for the insight needed to keep pace with the industry’s changing needs.
A carefully developed patient watch program that is specific to the facility and in tune to frequency of need through trend reporting will help ensure the safety of everyone involving and the continuous delivery of quality healthcare.
Kenneth Bukowski was previously vice president of healthcare at AlliedBarton Security Services. This article was originally published in 2016, and its recommendations still apply.
Note: The views expressed by guest bloggers and contributors are those of the authors and do not necessarily represent the views of, and should not be attributed to, Campus Safety.
