Inpatient psychiatric units have long required 15-minute checks as a part of mandated protocol to ensure the safety of both staff and patients. While some may question the efficacy of these checks, we believe they should remain a part of psychiatric staff members’ practice now and in the future, thus supporting the need to create and sustain a culture of patient safety — for the long term.
Basics on 15-minute Checks
Commonly known as Q15 minute checks, these essential assessments are often made by different types of behavioral health professionals. Patient safety checks are commonly done in 15-minute intervals when a patient is determined to be at risk of suicide, self-harm, and/or elopement, but varied time intervals are also accommodated in certain situations. If the patient is asleep, staff members are often required to check for three breaths to assuredly indicate that they are alive and well. If the patient is awake, patient safety checks typically include establishing eye contact, checking breathing, observing the physical environment, and documenting any notable behaviors.
This type of rounding offers documentation of the date, time, and relevant locations of patient safety checks. It’s important and compliant to verify the close observation of patients who have both physical and psychological needs that direct care staff are required to meet. 15-minute checks also help minimize risk, establish accountability, and deliver peace of mind to both staff and the family and friends who care about the patients involved. Patient observation systems have historically involved the use of paper and pen, but emerging technology has been recently leveraged to validate compliance for these safety checks.
The Necessity of 15-minute Checks
Each year, approximately 35,000 people die by suicide in the United States. As many as 1,800 (6%) of these suicides occur in inpatient psychiatric settings. Such startling statistics demonstrate how alarmingly common these tragic events are and how devastating the impact of these casualties are for family members and hospital staff — and legally damaging to the hospitals. Clearly, reducing the risk of suicide and other sentinel events in psychiatric hospitals is a critical issue that requires immediate consideration and emergency action.
Advocates of 15-minute checks cite the benefit of using them for at-risk patients who are transitioning off of one-to-one observations. Some patients also need more support than the general population, while not necessarily demanding constant monitoring. In addition, though sometimes necessary, one-to-one observations can lead to distress — on the parts of both parties — over the lack of privacy, while 15-minute checks may feel less intrusive to some. Finally, finite human and financial resources limit some hospitals’ capacity to offer one-to-one observations, so 15-minute patient safety checks commonly provide a valuable alternative.
Challenges in Conducting Q15 Minute Checks
Critics question why we need 15-minute safety checks, arguing that an individual who wants to take his or her own life can do it in 15 minutes. In fact, in a study of 76 patients who died by suicide in a psychiatric unit or immediately following discharge, 78% denied suicide ideation when asked, and 51% were on 15-minute checks or one-to-one observation.
Others support the continued use of Q15 minute checks, albeit with a few caveats. In their article, “The Utility and Effectiveness of 15-minute Checks in Inpatient Settings,” Geetha Jayaram, MD; Hilary Sporney, MSN; and Pamela Perticone, RN, state a need for using the 15-minute checks only in cases in which the patients are “not assessed to be at imminent risk for self-harm.” In line with these concerns, some behavioral health facilities support the optimization of 15-minute checks by conducting them within 15 minutes — and at random.
Comprehensive Risk Management
Of course, 15-minute checks are just one piece of the puzzle in ensuring patient and staff safety in psychiatric facilities. Other factors need to be accounted for in order to effectively prevent suicide and other adverse events through the use of patient safety checks. These include the proper treatment of anxiety and agitation, the development of a therapeutic relationship between staff members and patients, maintaining a healthy and positive environment, and managing comprehensive assessments of the patients’ behaviors.
The benefits of placing a patient on the checks versus the risk of not doing so should be included in a patient’s notes. Troubleshooting some of the difficulties in ensuring patient safety may also lead to better outcomes. For example, nurses have cited difficulty in consistently documenting the checks because of a wide range of other responsibilities. Sometimes the task of observation falls to an aide or assistant with less training. Distractibility, fatigue, or boredom could lead to inconsistency in validated observation compliance as well.
Empowering a Culture of Patient Safety
Psychiatric inpatient hospitals and other settings that treat mental health patients take careful precautions to prevent self-harm. This includes prohibitions against belts, zippers, pens, and more. Units are locked and visitors must sign in and out. Still, all staff members realize the risks that persist. When executed thoughtfully and strategically, 15-minute checks provide an extra level of protection for patients at risk, this also protecting staff from harm.
At InvisAlert Solutions, we are dedicated to developing technology that not only supports patient safety initiatives but ensures validated compliance. Our ObservSmart and ObservSmart 1:1 proximity-based rounding tools use patented, tamper-resistant wristbands, and mini iPads to coordinate and verify that 15-minute patient safety checks are done in compliance — every time.
Contact us today to learn more, or to request a demo.