Sunnyside Medical Center

When UBT co-leads at Sunnyside Medical Center took a closer look at their patient safety assistant usage, they agreed that reducing the number of hours was a top priority.

The patient safety assistants, also known as PSAs, were certified nursing assistants and provided a key service. They were assigned to sit in a room with a patient who had dementia, was confused or at risk of a fall. They could help if the patient tried to get out of bed, remove their IV lines, or became disoriented or restless.

And patients getting out of bed is not unusual.

Some try to get out of bed because they're bored and restless or they might need to use the bathroom. Restless patients often need a change of scenery, which might mean moving the patient to the nurses' station or to a public area. There might be a need to reduce noise by closing doors at shift change to keep it quiet.

During a five-month stretch, the Sunnyside nursing unit had used 1,550 hours on PSAs. At a cost of $62,000, they wanted to bring those hours down without adversely impacting patient care.

So staff members made it a priority to talk with the patients and families to learn about the patient's interests and hobbies and offer specific activities for patients to do during their stay.

"Using the activity boxes (which contain games, crafts, videos and more) with patients has been a great way to help patients stay busy, and it makes them feel better," according to UBT labor co-chair Glenda Vosberg, RN.

The goal was to reduce PSA usage by 10 percent in four months. Knowing this was going to be a full-team effort, a mandatory in-service was scheduled and the co-leads explained the situation to the rest of the team.

They trained staff on the options to using PSAs. They provided the team with baseline data and information on the financial impact of using PSAs, and had nurses assess patients to determine whether a PSA is needed.

The results were immediate.

In a month, hours dropped from 549 to 32 without any negative impact on patient safety. Within another two months, PSA usage fell to eight hours.

"Staff were given the data and information to help them understand the impact of the situation and get their feedback on alternative options to using a PSA," says Imelda Zapata, department manager and management co-lead.

The team also enlisted the assistance of Susan Woods, the clinical nurse consultant in the hospital.

One of Woods' responsibilities was to provide consultations with patients who were assigned PSAs. She worked with the patient, family and nurse to develop a plan that best fit the needs of the patient.

Kaiser Permanente also invested in several different equipment options, including low beds, which can be put all the way down to the floor, and bed and chair alarms that let nurses know if a patient tries to get up.

The combination of equipment, changes to the environment, and activities for patients allowed the team to keep their patients safe and improve their morale while decreasing the usage of PSAs.

"Often staff is concerned about patient safety when we talk about alternatives to assigning PSAs and may be reluctant to try other options. However, literature (and our local experience) shows that having a PSA in the room does not guarantee the patient won't fall or pull out their IV lines," Woods says. "We've found that reduction of PSA usage has not negatively impacted patient safety, just as the literature suggests."