Safeguards for Sitters

While attending Baker Act or Suicidal Risk Patients

Patient Services Policy #2.011

Table of Contents

Objectives Check the Environment

Purpose and Role of the Sitter Harmful Items

Why is a Patient on Suicide Precautions? Contraband

Responsibility Be Vigilant

Baker Act Be Aware of the Patient’s Mood

What does the Baker Act do? Tips for Dealing with Patients

Special Precautions Code Green -Patient Disturbance

Close Observation Baker Act and Suicide Prevention Checklist

Your Safety is Important! Summary

Objectives

In this module you will review how to:

• Define role the sitter performs with patient at hospital.

• Identify cause for patient to be placed on suicide prevention.

• Identify mandatory tasks and Plan of Care that RN must perform.

• Delineate the history and impetus for “Baker Act” legislation.

• Delineate necessary precautions sitters or clinical staff must take

when sitting for a patient.

• Identify harmful items and contraband that must be confiscated

from patient.

• Delineate Hospital Code to report combative patient/people and

Security Emergency extension.

• Review Baker Act and Suicide Prevention Checklist.

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• Purpose of this policy is to identify patients at risk for

suicide and to implement suicide precautions in order to

reduce the patient’s risk of harm to self.

• Hospital will provide safety for the patient in crisis in the

least restrictive environment that allows for appropriate

care within the capabilities of the facility.

• As a sitter, your duty is to directly observe patient’s

behavior and report any unsafe or threatening behaviors

or verbalizations to the RN immediately.

Purpose and Role of the Sitter

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Why is a Patient on Suicide Precautions?

• Patients seen in the ED or admitted to the

hospital for a recent suicide attempt should be

placed on suicide precautions.

• Any patient who is a Baker Act for serious self-

injurious behavior/or risk thereof should be

placed on suicide precautions.

• Patients who verbalize intent to harm themselves

or who have expressed a suicide plan should be

placed on suicide precautions.

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Responsibility

• RN will complete a suicide risk screening assessment on

all patients who come to Bethesda Health with a Baker

Act for serious self-injurious behavior, assessed to be at

risk for suicide or with a chief complaint that is

behavioral/emotional.

• Notify the physician of affirmative answers to the

questions and suicide precautions may be ordered by

the patient’s physician or designee as stated in the

Florida Statues.

• RN will initiate the Plan of Care, which is reviewed and

documented each shift.

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“Baker Act”

• Act was named for a Florida state representative,

Maxine Baker, who had a strong interest in

mental health issues, served as chair of a House

Committee on mental health, and was the

sponsor of the bill.

• Nickname of the legislation has led to the term

“Baker Act”. When a person is “Baker Acted”,

he/she is taken to a receiving facility for

involuntary examination when there is reason to

believe that he/she is mentally ill and because of

his or her mental illness, the person has refused

voluntary examination.

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What does the Baker Act do?

• Baker Act allows for involuntary examination

(what some call emergency or involuntary

commitment). It can be initiated by judges,

law enforcement officials, physicians or

mental health professionals. There must be

evidence that the person

a. has a mental illness (as defined in the Baker

Act) and

b. is a harm to self, harm to others, or self

neglectful (as defined in the Baker Act).

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Special Precautions

• Staff will take the patient’s clothing and personal belongings from the room, as the patient may be an elopement/safety risk. (Refer to Policy #1103 Patient Valuables)

• Special attention will be paid to medications, illicit substances, guns, knives, nail files, razor blades, metal objects, hatpins, glass objects, mirrors, etc. Cigarette lighter and/or matches must be removed from patient area.

• Have patient wear a hospital gown ONLY

• All medications brought it with the patient must be bagged, documented on receipt slips, and removed from the patient area immediately. (Refer to Operations Regulation # 2213)

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Close Observation

• Patients on suicide precautions require close

observation. A sitter or clinical staff member will

remain with the patient, keeping the patient in

eyesight at all times, in the room including when

the patient uses the bathroom. Patients should

be placed as close to the nursing station

as possible.

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Your Safety is Important!

• Be sure to maintain your safety by positioning

yourself between the patient and the nearest exit

from the area.

• You DO NOT want to trap yourself in the room in

case you need to get out of danger or get help.

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Check the Environment

• Make sure the room is free of

hazards and harmful items.

This is particularly important

during and right after visitors

are present. Visitors may leave

items accidentally or

intentionally.

• Check the bathroom before the

patient enters.

• Empty the trash and check for

other possibly harmful items

and remove.

TOC

• It is your responsibility to make

sure that the only food tray the

patient receives is a Styrofoam

tray with Styrofoam cups and

no utensils. Finger food only.

• DO NOT let the patient have

soda cans from the tray.

• Pour the soda for the patient into

a Styrofoam cup and do not

leave the can in the room.

Harmful Items

Harmful Items continued

• Belts, ties, straps,

shoelaces, suspenders,

scarves

• Lighters and matches

• Tape, plastic bags

• Aerosol cans, aluminum

soda cans

• Hair dryer, curling iron,

other electrical

appliances and cords.

Harmful Items continued

• If you find any harmful objects or contraband, take them from the patient and remove them from the room. Promptly give them to the nurse.

• Objects include:

• Sharp objects (nail files, razors, scissors, pocket-knives)

• Glass items, including picture frames, mirrors and makeup, perfume, aftershave

• Medications or illicit substances

TOC

Contraband

Contraband means items that are

strictly prohibited from the patient’s

environment.

• Weapons (guns, knives, etc)

• Drugs (prescription, over the

counter or illegal substances)

• Alcohol containing substances

such as mouthwash, perfumes.

(Hand cleanser is alcohol

based, so you will have to keep

a close watch)

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Be Vigilant

Check the area frequently for possible hazards such as the following:

• Hardware in room: Closet bars or racks, towel bars, hooks, showerheads, shower curtain rods, elevated TV stands, grab bars, light fixture, hinges or door handles can all be used to hang from.

Be Vigilant continued

Check the area frequently for possible hazards such as the following:

• Hardware in room: Closet bars or racks, towel bars, hooks, showerheads, shower curtain rods, elevated TV stands, grab bars, light fixture, hinges or door handles can all be used to hang from.

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Be Aware of the Patient’s Mood

If the patient shows any of the

following unsafe behaviors or

makes the following

statements, let the nurse know

immediately.

• Verbally threatens to harm

you or him/herself

• Self mutilation with any type

of object

• States specific plans to kill

oneself or someone else

Be Aware of the Patient’s Mood

If the patient makes statements such as:

• “I won’t be around much longer.” or

• “There is nothing worth living for

anymore.” or

• “I just can’t stand the pain any longer.”

If you have a sense that the patient’s

emotional state has changed abruptly, such

as calm and quiet to fiery and unsettled, or

vice versa.

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Tips for Dealing with Patients

Always take the patient’s threats of suicide seriously and report immediately to the nurse, Be aware that the patient has the potential to harm you in trying to harm him/herself.

Avoid the use of clichés such as:

• “There’s so much that life has to offer you.” or

• “ You have everything to live for.” or

• “I know how your feel.”

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Tips for Dealing with Patients

• Show caring and concern for

the patient and actively listen

to him/her. Ask simple and

direct questions when talking

to the patient and try to answer

the patient’s questions in the

same manner.

• Don’t argue with the suicidal

person about the philosophical

value of life versus death.

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Code Green - Patient Disturbance

• Call for help immediately if the patient tries to threaten

your safety or his/her own safety.

• Call a CODE GREEN – Dial 87777/77777, say Code

GREEN and your location.

• Call a Security Emergency- Dial 555. This will

immediately alert Security of the danger by directly

connecting you with a security officer.

• If you are in immediate danger flee the area as soon as

you’re able.

East Campus: 87777 or 855

West Campus: 77777 or 755

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Baker Act and

Suicide Prevention Checklist

• Nurse is accountable to oversee patient sitter to ensure

implementation of appropriate safety measures.

• RN and Sitter to complete the “Baker Act and Suicide

Prevention Checklist” at the time a patient is admitted to

room.

• 2 Sitters to complete the “Baker Act and Suicide

Prevention Checklist” at change of shift.

• Patient’s environment must be secured per the checklist.

• See the next page for an example of the checklist.

Baker Act and

Suicide Prevention Checklist

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Summary

In this module, you reviewed:

• The role sitters perform with a patient at hospital.

• Cause(s) that may contribute to patient to be placed on suicide

prevention.

• Identify mandatory tasks and Plan of Care that RN must perform.

• The history and impetus for “Baker Act” legislation.

• Precautions sitters or clinical staff must take when sitting for a patient.

• Harmful items and contraband that must be confiscated from patient.

• The Hospital Code to report combative patient/people and Security

Emergency extension.

• The Baker Act and Suicide Prevention Checklist.

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