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Hourly Rounding in a psychiatric unit

By Johanne LaFleur posted 12-08-2018 12:52 PM

  
My hospital is talking about implementing hourly rounding in the hospital including psychiatric unit.  Anybody has an idea how it can be done in a psychiatric unit since we cannot apply the 5 P because our patients are independent and come to us contrary to medical units.
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06-27-2019 09:46 AM

I work in a medium secure unit in Queensland Australia. We do what we call Visual (Psychiatric) Observations which from what I can understand is a combination of frequent checks & rounding. 
The purpose of Mental Health Visual Observations (MHVOs) is to apply a system of structured clinical monitoring and therapeutic engagement with mental health consumers who have been formally assessed as requiring intensive inpatient treatment and support. It involves ongoing assessment of a consumer’s mental state, continuous review of identified risks, and therapeutic engagement with the consumer to benefit treatment and enhance safety.
The level and type of observation, based upon the level of assessed risk. The assessment of risk is to include:
• Aggression / violence
• Absconding
• Suicide / self-harm
• Culture
• Sexual vulnerability
• History of predatory behaviours (sexual, predatory, financial or abusive)
• Age
• Falls risk
• Potential for wandering
• Consideration of the consumer’s current mental state and prescribed medications.
• Known/at risk physiological risk factors.

Levels of Observation
• Intermittent Observation – Patient is checked intermittently at allocated time between 15 minutes and 2 hours. These patients are assessed as potentially-but not at immediate risk-of serious harm to self and / or others. Assessed as potentially, but not immediately, at risk of seriously harming themselves or others
Considerable risk of absconding from a clinical environment which will place them or others at risk of harm. 

• Continuous Observation – Patients remain within constant visual contact of staff at all times. One clinician is allocated at all times to carry out this level of observation and should be exempt from other ward duties. These patients have been assessed as having more complex needs and associated risks secondary to their mental health status.

12-18-2018 11:18 AM

Hi Johanne - We did this on our inpatient psychiatric unit and asked that staff document the patients affect every hour after looking at this article:

https://www.ncbi.nlm.nih.gov/pubmed/21667813

Which was specifically on hourly rounds in mental health wards. If you want to ask anymore questions, feel free to reach out.

12-13-2018 01:25 PM

​Hello! We have been considering the same process for our units and recently started it for the geriatric population because it seemed more relevant. I found a great article and guide on what rounding could look like for a geri psych unit. We are still working on hardwiring this process with plans to hopefully bring to our adult units.

This is the article.
https://www.americannursetoday.com/impact-rounding-geriatric-psych-unit/​