STARS Interventions for Continuous Observation and Violence Reduction: Safety, Technology, Activity, Relief, Surroundings.

Document Type


Publication Date


Publication Title

15th Annual Seattle Nursing Research, Quality Improvement & EBP Conference


washington; olympia; psph


Purpose: To improve the feeling of safety and engagement among staff providing in-person 1:1 continuous observation (CO) for patients and to reduce the need for CO among patients in an acute care hospital.

Background/significance: Providence St. Peter Hospital is challenged to meet productivity by reducing the use of CO while keeping patients who require CO and the staff caring for them comfortable and safe. Staff without behavioral health expertise struggle to manage behaviorally challenging patients and are subjected to frequent episodes of violence from patients requiring CO. It is suspected that patient assaults on caregivers are underreported by staff. There is a gap in current knowledge concerning effective interventions to reduce the need for CO and violence toward caregivers with limited psychiatric resources.

Description: Over a 6-month time period, acute care patients requiring CO and staff providing the care were rounded on by a Nurse Leader. The Nurse Leader provided and discussed an educational tool kit for staff, patients, and families. The kit included evidence-based tools for improved communication during handoff, violence prevention, holistic patient care, and family engagement. Assault reporting education was also provided to staff. CO staff were encouraged to share input for the patient’s individualized care plan with the care team. Patients were assessed during each Nurse Leader round for readiness to trial on remote visual monitoring.

Evaluation and Outcomes: CO hours and assault frequency and severity data were tracked before the intervention and for the 6-month period while the intervention was implemented. No significant change was seen in the amount of the CO hours provided by the acute care units. Reported assaults appeared to increase. However, reported assaults with no injury appeared to increase at a higher rate than reported assaults with injury, suggesting an increase in reporting overall. A survey was distributed to all Certified Nursing Assistants (CNAs) providing CO to acute care patients during the intervention. Among CNAs who were rounded on more than once by a Nurse Leader to discuss the STARS interventions over the course of the project, the CNA survey demonstrated statistically significant positive responses to: 1) feeling safer when providing CO because of the STARS project; 2) feeling that the STARS project was helpful in reducing violence; 3) feeling that the STARS project brought attention to the importance of the CO role; and 4) belief that the STARS project improved CO care.

Conclusion: Structured, in-person rounding by a Nurse Leader on patients requiring CO and staff caring for them demonstrated increased feelings of CO staff safety and engagement.