Keeping Suicidal Patients Safe, Virtually

In this post-pandemic world, we are seeing an uptick in behavioral health patients across the u.s., especially in our vulnerable pediatric population. When we pair this with a shortage of mental health professionals, there is a risk in our ability to adequately care for this important demographic. One particular challenge is handling suicide ideation (si) patients in acute care facilities, as they require a one-to-one sitter for their health and safety.

With our current staffing situation, providing this sitter often means pulling a much-needed member of the care staff off the floor. This can exacerbate already strained staffing, which is why telesitter solutions are so important for low and moderate risk si patients and why AvaSure pulled together this panel for our annual symposium. There is a perception that telesitter solutions aren’t allowed or suitable for these patients – in reality,  policies may have to be adjusted, but most governing bodies allow for the virtual monitoring of si patients that are assessed to be low or moderate risk. Using a telesitter program for these patients can help reduce placing additional staffing constraints on your system while keeping patients safe.

Read below for key highlights from our panel discussion on this underutilized but important use case of the telesitter solution:

Q: Why did you first implement a TeleSitter program? Did you consider using it for SI patients at that time?

• HCA Methodist & St Peter’s Health both were primarily focused on falls prevention when first building out their programs and the inclusion of use on SI patients came down the road. Both saw challenges increasing where CNAs, RNs, and even administrators were being pulled to sit with patients exacerbating the need for another solution.
• Ascension Michigan started the program with SI in mind, but offsetting sitting costs related to patient falls were the driving factor

Q: Was there a perception that TeleSitter solutions couldn’t be used for SI patients & how did you overcome this challenge?

• Most hospitals have a policy in place that needs to be addressed & reviewed. In some instances, depending on state legislation, it may be important to include your regulatory/compliance managers as well. Ensure that you have an adequate screening tool in place – most customers on the panel utilized the Columbia suicide screening tool to assess for low/moderate/high risk. This will be important in case of an potential JCO visits that staff is aware that screening does take place before placing a patient on virtual vs. in-person sitting.
• As the program gets started, be sure to share good catches with hospital leadership, nurse managers, and front-line staff. This is key to building good will around the program and gaining support.
• Once the team understood that the devices do not record & are fully HIPPA compliant, there was no longer a concern about it potentially violating JCO regulations to utilize virtual monitoring

Q: Were there any specific challenges with getting physicians on board?

• Some physicians were hesitant at first, especially pediatrics. To help build confidence, multiple facilities conducted a pilot where a video monitor was used in combination with an in-person sitter who sat outside the room. This allowed for a safety net while they proved out the efficacy of the system.
• One panelist noted that less than a year into the program, providers don’t hesitate to rely on the TeleSitter staff for monitoring these patients
• However, all systems noted you’ll have to stay on top of educating new providers & residents as they join the system – so continue to share great catches even after initial implementation

Q: Are the monitor staff for SI patients required to be clinical or specially trained in any way differently from those monitoring for falls, elopement, etc.?

• All the systems on the panel utilize the same monitor staff which can be clinical but are not required to be when monitoring all patients – including SI
• The training modules on monitoring Suicide Ideation Patients from AvaSure were viewed by all as an essential tool in training staff to properly monitor this patient population
• One panelist recommended the best practice of rotating “on-site” 1:1 sitters and virtual monitors so they have an appreciation for both versions of the program helping to build consistency
• Another best practice is that if monitor techs aren’t yet at their maximum number of patients being monitored, consider having multiple monitor techs viewing a SI patient for an extra set of eyes on these patients
• In addition to training monitor staff, it’s essential to train bedside staff. Most aren’t adequately educated on the details of their hospital policy regarding sitting & sharing stories of what could happen when things go wrong can help to drive the need for compliance.

Q: What advice do you have for customers just thinking about rolling out a TeleSitter program for monitoring SI patients?

• Consider your use cases when selecting devices. Not all TeleSitting devices are ligature free, so if you’re thinking about monitoring SI patients from the onset or down the road, share this with your vendor to ensure you purchase the correct devices
• Hold a roundtable with various departments allowing for open conversation between leaders prior to rollout. This can help to identify any areas of concern that you can then be laser focused on addressing.
• Don’t underestimate the number of cameras you’ll need – Kim Beckett from Ascension said the program would be easier to manage with a camera in every patient room!
• “It’s possible, efficient & effective. The camera prevents harm,” said one panelist while another noted, “don’t hesitate. Education is how you overcome any potential pushback. The results will speak for themselves.”

The team was able to share several great catches, all noting they have not yet had a successful attempt on a patient being monitored by their TeleSitter program. In addition to more typical catches, such as a patient attempting to strangle themselves with heart monitors, they also caught things like a patient who was able to smuggle in materials from the outside & an incident where an on-staff security guard entered a pediatric patient room and was overly aggressive with the patient. Events like this have caused the facilities to think outside the box on future potential use cases for their TeleSitter programs – such as watching infants for potential abduction, monitoring eating disorder patients & keeping an eye on family members in the room for potential staff or patient injury & medication theft. With a well supported program, the use cases truly are endless. If you’d like to learn more about potential use cases, we’d be happy to complete a complimentary on-site assessment and make recommendations.

​​Watch the recorded session

Panelists:

• Debbie Cronin, RN, Director of Patient Care Services, St.Peter’s Health
• Kim Beckett, RN Manager – Clinical Surveillance, Ascension Michigan
• Wesley Wingate, Director Cardiac Telemetry, HCA Methodist