Patient Safety on a Behavioral Health Unit

Patient safety – preventing death or severe permanent harm – is of the greatest concern in any medical facility, particularly Behavioral Health. Because of the vulnerability of patients admitted to inpatient behavioral health units (BHU), safety risks to consider include serious self-harm and suicide.

According to a study published in Frontiers in Psychology in December 2020, inpatient suicides are relatively rare incidents (about 1.4% of admitted patients in the U.S.) – and they’re also on the decline. By creating a culture of safety among an entire BHU team, we can aim to reduce those rates even further.

In this blog post, we’ll share two ways to help increase safety in a behavioral health unit: 15-Minute Safety Checks & Environmental Rounding.

15-Minute Safety Checks

The first way to help reduce risk is by consistently observing the patient. We call these observations, 15-minute checks. Checking on patients at regular intervals – no more than 15-minutes between observations or checks has become an industry standard to minimize the risk for self-harm, violence, and death by suicide.

Rebecca Dvorak, senior vice president for clinical practice at Horizon Health, is a strong proponent of safety checks in behavioral health. “The consistent checks by staff is a foundation of safety in a behavioral health program. At least every 15-minutes, a staff member should lay eyes on the patient, ensuring their needs are being met and they are safe in the environment,” she says.

Dvorak, who helps hospitals build, develop and improve behavioral health programs, adds that 15-minute checks in a BHU is more than laying eyes on a patient; it’s also about assessing the environment. She walks us through an imaginary scenario of what that might look like when performing 15-minute checks: “Does the person appear safe? Does anything look out of place? Do they have more belongings than required (extra sheets, towels, clothes), which could pose a risk to them or others?”

A typical 15-minute check might include:

• Making eye contact with the patient
• Observing mood and behavior
• Ensuring the patient is in no acute distress
• Visually observing the physical environment for anything unsafe – or for any restricted items

[Note: It’s important to clarify that 15-minute checks are not recommended for patients at an elevated or extreme risk of suicide; rather, these patients should be placed under close observation. This involves constant, one-to-one monitoring by a behavioral health professional who stays within arm’s distance of the person at all times to ensure safety.]

Environmental Rounding

The second way staff help keep patients safe on behavioral health units is by performing environmental rounds. Environmental rounds are used to assess the area/unit for any potential risks to the patient and/or staff.

During an environmental round, an assigned staff member walks the unit, including all patient care and non-patient care areas. The staff member is looking for any items that could harm, or be used to cause harm, to a patient and/or staff person.

Environmental rounding is performed in a couple of different ways. The first is a more formal approach, which is completed every shift, utilizing a standardized tool and documented. The second way is by completing environmental checks each time the staff member completes a 15-minute safety check. Combining both of these methods helps to ensure that the environment is continually being assessed and kept safe at all times.

In Summary

In behavioral health safety has to be taken into consideration at all times. 15-minute safety checks and environmental rounding are just two of the ways behavioral health leaders help keep the patients and staff safe. “As healthcare workers it is our duty, our responsibility, to keep patients safe while they are in the hospital,” says Dvorak, adding that 15-minute checks and environmental rounding can help minimize risk and, thus, improve safety in behavioral health units. “The reality is, patient safety events are preventable.”

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Among its many solutions for behavioral health programs, Horizon Health’s Clinical Resources team helps inpatient and outpatient BHUs identify strategies to minimize risk and ensure safety of all patients and staff. Learn more about our clinical resources here.