| Sumario: | Significance & Background: Using sitters to care for hospitalized adults with challenging behaviors can be expensive and lacks strong evidence supporting its effectiveness. Nevertheless, this practice remains an essential strategy for preventing falls at a large academic medical center. Before project implementation, there were no established guidelines for the use, renewal, and discontinuation of sitters. This absence of guidelines raised concerns about the increasing costs associated with their utilization. A review of the literature indicated that it is possible to reduce the reliance on sitters while maintaining patient safety by developing clear guidelines, providing effective training, and implementing standardized decision-making tools. Purpose: To implement a quality improvement project that reduces sitter usage by 50% for non-suicidal adults with high-risk behaviors, while ensuring that the fall rate remains unaffected in a 32-bed medical oncology unit. Interventions: Four tools were developed and implemented to standardize the use of sitters. First, a sitter decision tree was created to help nurses determine the appropriate circumstances for utilizing a sitter. Second, a sitter justification form was designed to improve communication of sitter requests to the leadership team. Third, a letter was drafted for patients and their families to inform them about the sitter program. Finally, a scripted guideline was developed to assist nurses in addressing any reluctance from patients or families regarding the discontinuation of the sitter. Before the project launched in January 2025, a mandatory virtual training session was held for all nursing staff. Results: An analysis conducted six months before and after the intervention revealed a 73% reduction in sitter hours, decreasing from 3,776 hours to 1,011 hours. This indicates a significant change following the implementation of the intervention. The average fall rate remained consistent at 2.0 both before and after the intervention. Results from the staff survey showed that most nurses did not observe any changes in their workload and felt confident that patient safety was maintained under the new guidelines. Discussion: Implementing standard procedures for using sitters has significantly reduced the number of hours required for their services. This demonstrates that having formal guidelines improves patient safety without needing additional staff. Furthermore, mandatory training for nurses was essential in gaining their support for these changes.
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