Patient Observation Safety and Security Risks

For those working in healthcare security we know that security officers are often called upon to perform duties that are not security related. For example, security officers have been tasked with retrieving things such as blankets and drinks for patients. Traditionally these types of tasks were handled by clinical staff. Security officers on the other hand are intended to provide safety and security services in order to maintain a safe and secure healing environment. Somewhere along the way practices have changed in many healthcare environments.

Mental Health Patient Monitoring

Depending on what part of the country, or even what facility you are in, the assignment of actively watching a behavioral health patient can be called a number of things. For example it may be called a patient standby or patient watch. Traditionally it is one in the same; a staff person assigned to monitor an at risk patient for safety or security reasons.

Behavioral health patients in the Emergency Department (E.D.) or in the inpatient units of the hospital present numerous challenges and risks. There is the risk of the patient eloping (leaving against medical advice), harming themselves including committing suicide, and the risk of them harming someone else (e.g. a staff person or another patient).

In most cases a patient that is deemed a danger to themselves or others is not allowed to leave the facility, yet they still find ways to do so. Not all medical centers have secured units to house these patients while they receive or await mental health treatment, and as a result the healthcare facility will either house these patients in the E.D. or in an inpatient area and they will often assign someone to “watch” the patient.

There is an estimated 5,723 registered hospitals in the United States (source: American Hospital Association), and many of them do not have a security department in place. In those facilities the assignment of patient monitoring may be assigned to a nurse, Certified Nursing Assistant (CNA), orderly, or a position such as a department secretary. In hospitals that do have security officers on staff they may still use one of the above mentioned staff members or they may assign a security officer to conduct the patient watch.

Whatever route that a medical center elects to go they need to insure that person that is monitoring the patient is properly trained. In a recent case in Bethlehem, Pennsylvania a hospital was fined by the Pennsylvania Department of Health for not properly training their security officers for the task of patient observation. In this case a security officer was assigned to continuously observe the patient, yet the patient opened a 6^th floor bathroom window and jumped to his death.

Untrained Staff and At-Risk Patients

Over the years staff members have been assigned to watch at-risk patients for signs of distress, high-risk medical conditions, and suicidal tendencies. However, in many cases the staff person assigned to such duties had received little or no training in what to watch for.

In one such case security was called upon to observe a mental health patient in the E.D. who had attempted suicide by means of an overdose. Security was told to “watch her for any signs that she is in distress, and if you see anything call the nurse station.” However, security officers were not trained to know what constitutes a “state of medical distress.”

Trained Staff for Patient Watches

It is imperative that healthcare facilities properly train any staff personnel that are assigned to monitor a patient whether or not that patient is at risk. Assigning an untrained staff person to monitor a patient that is not properly trained is an unnecessary risk and could result in an adverse outcome, including death.

Staff assigned to such a role has to be trained, and they need to have an assessment of competency to insure that they are proficient in their assigned duties.

To read more about this subject check out page 3 of this news story regarding Observation Training for Security Officers.