Patients at Risk for Self-Harm or Harm to Others: Safety Rules While in the Hospital

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Patients at risk of harming themselves or others are placed on safety precautions as soon as they enter the hospital. These safety rules are in place during the entire hospital stay but may change over time based on how your child is doing. They are designed to promote a safe place for all patients, for you and for our staff while in the hospital.

What Happens Next

During the first 24 hours after being admitted to the hospital, a staff member from Social Work, Psychology or Psychiatry interviews your child. These interview sessions help us understand what is happening. We want to find the best way to help your child get medical treatment. After the interviews, a member of the psychosocial team will work with you, your family and the doctors who are caring for your family member.

Constant Monitoring

A member of hospital staff provides supervision for your child at all times.

  • Staff must be able to hear the patient while they are using the bathroom or shower. The door must stay open at least 6 inches. This lets the staff providing supervision talk to the patient or know if they need help. A parent or guardian can be in the bathroom.  
  • Showering:  the staff providing supervision stays outside the bathroom talking to the patient when they get ready to shower. Once they tell staff they are in the shower, the staff member will enter the bathroom and talk with them during the shower. When done showering, the staff member will leave the bathroom and follow the policy for bathroom and toileting activities. This includes talking with them and them answering verbally. A parent can be in the bathroom during this time. With the parent in the bathroom, the door will stay open and the staff providing supervision will stay in the bathroom doorway.
  • During bathroom time, if the patient does not answer, the staff providing supervision cannot see them or they are harming themselves, the staff providing supervision will escalate the concern. Staff will enter the bathroom or shower to stop the self-harming activity.
  • Patients are usually in their room except for medical treatments and tests. The staff providing supervision will go with them to the rec room, during walks or when they leave the room or unit for another reason.
  • The hospital has a response team to assist and keep patients safe if there is a concern.

Approved Visitors

  • Only parents, legal guardians and grandparents may visit. Only 2 visitors can be in the patient’s room at a time.
  • Those on the approved visitor list must know the patient’s guest code. The guest code is a one-word password chosen by the parent or guardian at registration. The guest code is required to get a guest badge. No one other than those on the list can visit, even if they know the guest code.
  • Visitors should limit cellphone use. Cellphones can only be used outside the room.
  • The patient’s clergy may visit if requested.

Personal Belongings

  • A list of the patient’s belongings is made when they arrive and then stored. Parents and guardians can ask the nurse for their child’s belongings.
  • All patient rooms are checked. Anything that might be dangerous will be removed.
  • Patients wear a hospital gown and non-tie bottoms. No underwire bras, jewelry, hair accessories or ornaments are allowed. A bra without underwire may be worn. The only other non-clothing items your child may have are eyeglasses and hairbands without metal that are less than 2 inches around.
  • Head coverings for religious reasons may be worn. They will be removed for a safety check.
  • All visitors’ belongings will be searched or secured in a locked cabinet or drawer on the unit. Any items that may be dangerous will be taken, listed and stored until your visit is over. You can also use lockers located in the Family Resource Center to store these items. Dangerous items include anything sharp or pointed, cords, electronic devices other than your cellphone, anything glass or in a glass container or anything dangerous to swallow or insert into a cut or wound.
  • Flowers, balloons or gifts or any kind are NOT allowed. If approved, cards and e-cards may be given to the patient.

Permitted Activities

  • Patients cannot have a cell phone or make calls from their room. There is no hospital phone in the room. Five-minute calls are made from the nurses’ station to an approved visitor only. The staff providing supervision goes with them and places the call. This makes sure the person called is an approved visitor.
  • TV is allowed, but the attendant or nurse will monitor what is watched. Content with violence, sex, adult language or suggestive dialogue or behavior may not be viewed.
  • Personal video games or internet are not allowed. Video games are in the rec room.
  • Patients may read books, magazines or other things if they do not have staples or paper clips. The staff providing supervision will monitor what is being read.

We know this is a very stressful time for you and your family. If you have any questions about any of the safety measures, ask to speak to nursing staff, your child’s doctor or anyone who interviewed you. These safety measures may seem difficult, but they help keep everyone safe during the hospital stay.

After 24 hours and at a minimum every 24 hours the clinical team will re-evaluate these safety needs based on your child’s behavior and clinical situation. The following will be re-evaluated and MAY be allowed:

  1. Walking on the unit with the constant attendant for a prescribed amount of time and frequency
  2. Supervised access to computer and internet for a prescribed amount of time and frequency to allow completion of school activities.
  3. Access to some personal items
  4. Access to an approved activity box of items prepared for patients who are at risk for self-harm.
  5. Supervised access to electronic devices without internet, excluding cell phones.
  6. Visitors

Staff Member

I ________________________________ have reviewed the Safety Rules with family.

Date _____________________________

Parent

I ________________________________ have reviewed the Safety Rules with staff.

Date _____________________________

Children at Risk for Self-Harm or Harm to Others: Safety Rules While in the Hospital (PDF)

HH-IV-125 3/22 Copyright 2011, Nationwide Children's Hospital