An observer is an individual who provides constant bedside observation, monitors patients to prevent injury, and confirms that the patient is safe. Observers can be called patient safety assistants, companions, one-to-one observers, or patient sitters. These observers are often employees of the facilities, or are contracted from other companies. Typically, a registered nurse is responsible for assigning a sitter to patients that meet certain criteria: risk of falls, elopements, suicide, etc.

There are several types of observers, often with overlapping duties. One-on-one, or face- to-face, observers are responsible for continuous observation in order to prevent injuries to high-risk patients. These observers, along with other sitters or companions, fall under the supervision of an RN. The one-on-one observer is there to provide for optimal patient safety and comfort. These companions often provide assistance with activities of daily living and act as support for the healthcare team of the patient.

Tele-monitor, or remote monitor, sitters monitor at-risk patients via video surveillance. They provide continuous observation and often maintain communication through the phone or computer. Tele-monitor sitters also document the activities of the patient every half hour, or as required by organizational policy.

The role of observers revolves around high-risk patients. High-risk patients are often individuals who have high medical acuity and instability, who have communicated suicidal or homicidal inclinations, are an elopement risk, or have been involuntarily committed. High-risk patients could show patterns of falls or of dislodging medical devices, along with high levels of confusion or disruption. There are also several mental health issues that indicate high-risk status: dementia, delirium, substance abuse, schizophrenia, or mania (Colman, 2016).

Training Methods

Two-Day Patient Safety Aide Training

There are several methods used to train observers. Two-day Patient Safety Aide Training proved to be useful through Colman’s examination of his own hospital environment. This

study dictates that it is imperative that a nationally recognized set of standards of what is expected of the patient observer be established. These standards will alleviate role confusion between facility staff and observers, while maximizing the efficiency of the observers. A common issue that many observers face is that they are uncertain of exactly what their duties are, which can cause overlap into nursing duties. This creates friction between the staff and is not beneficial. Creating a standard will remedy this issue.

Key Elements

A well designed training program should include the following:

  • Orientation and competency validation program that includes a full day of prevention and management of disruptive behavior training
  • Identification and management of aggressive patient behaviors using a recognized program
    • This training must be completed prior to contact with any patients
  • Role playing situations involving verbal and physical signs and symptoms of agitation
  • De-escalation techniques
  • Tutorial on dangerous object removal
  • Fall prevention and suicide prevention
  • Safe use of technology and equipment
  • How to take vital signs, if needed
  • Dislodging medical equipment during bathing
  • Personal patient care
Training Timeline

Day One

  • Orientation to facility and observer policies
  • Description of duties
  • Skills for patient care
  • Skills necessary for intervention
  • How to properly document
  • Federal government contract agency logistics

Day Two

  • Prevention and Management of Disruptive Behaviors (PMDB) class
    • Educational and interactive demonstration for different methods of high-risk patient safety interventions
      • Examples: combativeness, elopement, suicidal and homicidal thoughts, involuntary commitment