The Utilization of Close Observation in Acute Psychiatric Inpatients

Abstract

Close observation is a psychiatric interventional method implemented for individuals who are displaying self-injurious or aggressive behaviors. This is a widely used intervention within the field of mental health Close observation is also regulated by The Joint Commission and the Centers of Medicare and Medicaid Services for accreditation purposes. A review of the current literature was conducted and revealed that frequently psychiatric patients are placed on inappropriate levels of close observation, that revisions to the close observation policy/practice improve both psychiatric patients and staff safety outcomes, and can overall decrease hospital costs associated with observation intervention. The purpose of this project was to examine the utilization of close observation at an adult psychiatric in-patient facility in Anchorage, Alaska. The Plan Do Study Act model was used as an organizational framework to guide this project. The methodology of the project involved reviewing inpatient psychiatric records, to generate the project’s data for analysis under a process that was monitored by Alaska Psychiatric Institute’s risk management department. Subsequently, the principal investigator organized and statistically analyzed the collected data using the Chi Square method of statistical analysis. The Chi Square

statistical method analyzed the differences between the various levels of close observation, self- injurious and aggressive behaviors. The results of the statistical analysis support

recommendations to revise the current close observation protocol and practice at Alaska Psychiatric Institute. The evidence generated was used as a forerunner to revise policy that was aimed at improving the utilization of close observation. The project results were disseminated to API via presentation to key stakeholders. The project was catalogued at the University of Alaska Anchorage per protocol.