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Direct observation nursing: adverse patient behaviors and functional outcomes
1Department of Rehabilitation Medicine, Mount Sinai Medical Center, New York, NY, USA.
Nursing Economic$
|July 20, 1999
Summary
This study identified patient behaviors and cognitive issues predicting the need for direct observation (DO) in rehabilitation. Understanding these factors can optimize patient care and reduce costly monitoring.
Area of Science:
- Rehabilitation Medicine
- Patient Safety
- Healthcare Management
Background:
- Direct observation (DO) is costly, estimated at $78,000 annually per patient.
- Patient behaviors and cognitive deficits, often seen in traumatic brain injury (TBI) and stroke patients, can lead to adverse events like falls.
- Medical immobilization (restraints) has negative consequences, prompting the need for alternatives like continuous nursing observation.
Purpose of the Study:
- To identify patient behaviors and cognitive problems predictive of the need for 1:1 or 1:2 staff direct observation (DO).
- To understand significant differences between patients requiring physician-ordered DO and those who do not.
Main Methods:
- A study was conducted on a 36-bed rehabilitation unit.
- All patients admitted between October 1995 and April 1996 were included.
- Analysis focused on comparing patients needing DO with those not requiring it.
Main Results:
- The study aimed to ascertain significant differences in patient characteristics leading to DO.
- Identified behaviors and cognitive issues associated with higher DO needs.
- Provided data to inform resource allocation for patient monitoring.
Conclusions:
- Identifying predictors for direct observation can improve patient management in rehabilitation settings.
- Optimizing DO reduces unnecessary costs and the use of restraints.
- Further research can refine criteria for direct observation to enhance patient safety and care quality.