The Impact of Nursing Protocols on Continuous Special Observation

Area of Science:

• Psychiatric Nursing
• Patient Safety
• Healthcare Management

Background:

• Continuous Special Observation (CSO) is a costly and intrusive method for monitoring at-risk patients.
• Two nursing protocols, Psychiatric Nursing Availability (PNA) and Psychiatric Monitoring and Intervention (PMI), were developed as alternatives to CSO.
• These protocols stem from a model promoting autonomous nursing decision-making.

Purpose of the Study:

• To evaluate the impact of PNA and PMI on the frequency and duration of CSO.
• To determine the effectiveness of new nursing protocols in reducing the need for continuous patient observation.

Main Methods:

• A nine-year descriptive retrospective analysis of CSO, PNA, and PMI data.
• Data were collected from unit 15-minute rounding sheets.
• Interrupted time series analysis was employed to assess protocol effects on CSO frequency and duration.

Main Results:

• Psychiatric Nursing Availability (PNA) did not significantly alter CSO use.
• Psychiatric Monitoring and Intervention (PMI) implementation correlated with a decrease in CSO episodes (0.07 per month, p = .0111).
• The median duration of CSO significantly decreased from 66 to 33 hours after PMI implementation (p = .0004).

Conclusions:

• Psychiatric Monitoring and Intervention (PMI) demonstrated a significant positive impact on reducing CSO.
• PMI indirectly enhanced staff availability, further influencing CSO reduction.
• The nursing care model emphasizing autonomous decision-making may have contributed to the observed decrease in CSO.