Behavioral Health Issues Clinical Pathway — Emergency Department

Immediate Safety Observation

All children presenting at risk for self-harm, aggression, suicide, or elopement require appropriate 1:1 Safety Observation.

Ask FLOC to enter Epic Order ASAP for appropriate observation level.
During observation, the child is restricted to the ED except for medically necessary tests. Two staff members should accompany children who require safety observation for all tests or transports within the hospital.

Reference Guide for Safety Observation Levels (1:1 Observation) Job Aid

Observation Type	Indications
Visual Moderate Risk	Risk for: Aggression, elopement, falls, self-harm related to poor judgment/intoxication/altered mental status, sexually acting out, admitted for medical treatment of complications from a suicide attempt who do not have a clear desire or concrete plan to harm themselves, and children in restraints. Child is within eyesight at all times Restricted to the unit except for tests, procedures
Visual and Arms Length High-risk	Children who verbalize a clear desire to kill themselves. Presents a clear and present danger to themselves or others. Children who demonstrate impulse dyscontrol or impaired judgment that could result in harm to self or others. Child is within eyesight, and arms reach at all times Restricted to the unit except for tests, procedures
2:1 Very High-risk	Highly aggressive, pose immediate threat to themselves and/or staff On witness care

Safety Observer Responsibilities

Daily Responsibilities	Engages the child in the EDECU daily plan Hygiene, meals, school, unit activities Considers same-sex observer during personal hygiene Monitors, reports, prevents self-harm behaviors Reviews All about me Card Provides emotional support
Communication	Shift Start Introduce themselves to the team Write name, shift time on the communication board Participates in bedside rounds During the Shift Engage child when they are alone, be in the room Facilitate: Conversations, encourage socialization with other children (playroom) Activities, use Child Life as a resource to choose best activity School activity with Education Specialist Report changes in child behaviors to the RN throughout the shift Change of Shift Summary at time of all hand-offs, including breaks and shift change Update on mood, activity of child, any concerns Participate in room checks twice daily, and when pt returns to room from activity Notifies RN when visitor arrives for safety check Psychiatric Technician Change of Shift Safety Check List

Daily Responsibilities

Engages the child in the EDECU daily plan
- Hygiene, meals, school, unit activities
- Considers same-sex observer during personal hygiene
Monitors, reports, prevents self-harm behaviors
Reviews All about me Card
Provides emotional support

Communication

Shift Start
- Introduce themselves to the team
- Write name, shift time on the communication board
- Participates in bedside rounds
During the Shift
- Engage child when they are alone, be in the room
- Facilitate:
  - Conversations, encourage socialization with other children (playroom)
  - Activities, use Child Life as a resource to choose best activity
  - School activity with Education Specialist
- Report changes in child behaviors to the RN throughout the shift
Change of Shift
- Summary at time of all hand-offs, including breaks and shift change
  - Update on mood, activity of child, any concerns
- Participate in room checks twice daily, and when pt returns to room from activity
- Notifies RN when visitor arrives for safety check
Psychiatric Technician Change of Shift Safety Check List

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The clinical pathways are based upon publicly available medical evidence and/or a consensus of medical practitioners at The Children’s Hospital of Philadelphia (“CHOP”) and are current at the time of publication. These clinical pathways are intended to be a guide for practitioners and may need to be adapted for each specific patient based on the practitioner’s professional judgment, consideration of any unique circumstances, the needs of each patient and their family, and/or the availability of various resources at the health care institution where the patient is located.

Accordingly, these clinical pathways are not intended to constitute medical advice or treatment, or to create a doctor-patient relationship between/among The Children’s Hospital of Philadelphia (“CHOP”), its physicians and the individual patients in question. CHOP does not represent or warrant that the clinical pathways are in every respect accurate or complete, or that one or more of them apply to a particular patient or medical condition. CHOP is not responsible for any errors or omissions in the clinical pathways, or for any outcomes a patient might experience where a clinician consulted one or more such pathways in connection with providing care for that patient.