Background: Patients with dementia, encephalopathy, TBI, autism, psychiatric illness, etc., frequently suffer from anxiety and/or agitation during hospitalization. Among items which have demonstrated an effective calming modality are weighted blankets (Mulen, Champagne, Krishnamurty, Dickson, & Gao, 2008). For the months of June through November 2019, patients on the trauma medical-surgical unit required more than 2,600 hours of constant supervision from their admission throughout their stay in rehabilitation or discharge to home, with an average of 435 hours per month. The goal of this quality improvement project was to decrease the need for one-on-one constant supervision with the integration of the “let’s be calm” boxes. Falls prevention was also monitored during the intervention period. This particular unit maintains a consistent falls rate below the national benchmark. These boxes included multiple non-invasive interventions such as weighted blankets, fidget spinners, baby dolls, and other distraction items for patients suffering from agitation or dementia. The cost of the boxes was funded by an internal grant.
Purpose/aims of project • Decrease unit-based constant supervision rate from baseline (average of 435 hours) per month to an average of 370 or less • Increase compliance of use of the boxes to 90% of constantly supervised patients • Reduce falls rate by 10%; current benchmark (2.20 falls per 1000 pt days)
Methods: The grant allowed for the initial purchase of 20 baby dolls, 20 weighted blankets, word search books, and fidget spinners. Let’s be calm boxes were created with these items and stored on the unit. Criteria for use were established, shared with staff, and posted on the actual boxes. Staff were instructed to use items they felt would benefit their patients, and a list was created to track the results. The nurse manager created a spreadsheet in her computer where patient outcomes (constant supervision hours and falls) were tracked. The staff received monthly feedback regarding the boxes and the positive impact they were having on constant supervision while maintaining the unit’s falls rate well below benchmark.
Subjects/setting: All patients admitted to the acute trauma unit at risk for falls at a level-1 trauma academic medical center were included. The unit has an average daily census of 24, the length of stay of 3.37 days, and there is a staff of 33 registered nurses and 16 ancillary staff.
Results: The unit achieved a decrease in the average monthly use of constant supervision of 195 hours for a 5-month period, with two months at zero constant supervision hours. This was a decrease of 55% from the baseline. This was paired with a 36% decrease in the unit falls rate and well below the national benchmark for falls of 2.28 falls per 1,000 patient days.
Implications for nursing: Agitation is extremely distressing to both family and caregivers alike. Dissemination of knowledge and best practices regarding managing agitation, sharing of distraction strategies, and implementation of calming interventions has improved the management of agitation on this unit and throughout the medical-surgical service line.