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

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Children at risk of harming themselves or others are placed on safety precautions as soon as they enter the hospital. These safety rules remain in place throughout the child’s hospital stay. They are designed to promote a safe place for all patients, for you and for our staff while your child is in the hospital.

What Happens Next

A licensed mental health clinician talks with you and your child in the Emergency Department (ED). If your child is admitted to the hospital, a staff member from Social Work, Psychology or Psychiatry will also interview you and your child. This happens within the first 24 hours of your child’s admission to the hospital. These sessions help us understand what is happening. We want to find the best way to help once your child receives medical treatment.

After the interviews, the staff member who interviewed your child will work with you and the doctors who are caring for him.

Constant Monitoring

  • A member of the hospital staff, called a Constant Attendant, will need to stay with your child all the time.
    • Staff must be able to see your child while he or she is using the bathroom and shower though a parent or guardian may also be physically present in the bathroom. The bathroom door will remain open at least 6 inches in order for the constant attendant to keep verbal contact (talking to your child) or see activity if necessary.
    • Showering activities: the constant attendant will stay outside the bathroom talking to your child while the child readies for the shower. Once the child tells the attendant he or she is in the shower, the attendant will enter the bathroom and talk with your child for the rest of the shower time. When the child has finished showering, the attendant will leave the bathroom and follow the policy for bathroom and toileting activities. This includes talking with your child and the child answering verbally. Again a parent may also wish to be present in the bathroom during this time. If that is the case the door will remain open with parent in the bathroom and the constant attendant in the doorway of the bathroom.
    • If your child does not answer and is not in the attendant’s line of sight, or if the child is harming himself, the attendant will alert staff, who will enter the bathroom or shower to stop activity that is self-harming.
  • Your child is not allowed out of his room or off the unit for any reason except a necessary medical treatment or test. The constant attendant will go with your child if he does need to leave the room or unit.
  • The room and the unit are not locked.
  • Hospital security is called if your child tries to leave the unit alone or if he tries to hurt himself or others. This is to keep your child and other people on the unit safe.

Approved Visitors

  • Only parents or legal guardians and grandparents may visit. Only 2 visitors can be in your child’s room at any time.
  • The people on the approved visitor list must know your child’s guest code. The guest code is a one-word password chosen by parent or guardian at registration. The guest code is required for guests to get a guest badge. No one other than those on the list will be allowed to visit your child, even if another person knows the guest code.
  • Visitors should limit use of their cellphones and use them only outside the room.
  • Your child’s clergy person may visit if requested by you or your child.

Personal Belongings

  • Your child’s belongings will be listed then stored. See the nurse to get your child’s belongings.
  • Your child’s room will be checked and anything that might be dangerous, like trashcan liners, will be removed.
  • Your child must be clothed only with a hospital gown and non-tie bottoms. No athletic supporter, 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 in diameter.
  • Head coverings worn for religious reasons may be worn after first being removed for a safety check.
  • Your child’s belongings will be listed and stored. Please see a nurse to get your child’s belongings.
  • Your child’s room will be checked for safety. Anything that might be dangerous will be removed.
  • Your belongings and the belongings of any other visitor will be searched each time you go into your child’s room. Any items that may be dangerous may be taken, listed and stored until your visit is over OR you have the option to keep the items off the unit. There are lockers available in the Family Resource Center. Dangerous items can include: anything sharp or pointed, any cords, any electronic devices other than your cellphone, anything glass or in a glass container, anything dangerous to swallow or insert into a cut or wound.
  • Flowers, balloons or gifts of any kind are not allowed. Cards and e-cards may be given to patient during the admission if approved by the licensed mental health clinician.

Permitted Activities

  • Your child is not allowed to have a cell phone in his possession or to make any calls from his or her room. The phone will be removed from the room. He or she can make a 5-minute call from the nurses’ station to one of the approved visitors. The attendant will go with him or her and will dial the phone to make sure the person called is one of the approved visitors.
  • TV is allowed, but the attendant or nurse will monitor what is on the TV. Content that includes violence, sex, adult language or suggestive dialogue or behavior may not be viewed.
  • No video games or internet access is allowed.
  • Your child may read books, magazines or other things as long as there are no staples or paper clips. The attendant will monitor what is being read.
  • We know this is a very stressful time for you and your child. If you have any questions about any of the safety measures, please ask to speak to nursing staff, your child’s doctor or anyone who has interviewed you. These safety measures may seem inconvenient, but they are in place to assure everyone’s safety during your child’s 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 _____________________________


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 5/14 Copyright 2011, Nationwide Children's Hospital