Speaker
Description
Background
Maintaining patient and staff safety while supporting least restraint care remains a priority in acute care settings, particularly for patients with cognitive, behavioural, or mobility-related risks. Variability in observation and least restraint practices across inpatient units identified opportunities to improve consistency. Evidence supports structured observation approaches, including virtual monitoring and patient safety attendant models, to enhance patient safety and behavioural management (Abbe & O’Keeffe, 2021; Ahmed et al., 2024). At Kingston Health Sciences Centre, the Least Restraint Policy was revised and standardized Patient Safety Attendant (PSA) and Virtual Patient Observation (VPO) policies were developed, informed by three RNAO Best Practice Guidelines.
Aim
To strengthen safe, consistent, and least-restrictive approaches to patient observation, behavioural management, and fall prevention through implementation of structured PSA and VPO practices.
Methods
Using a Knowledge-to-Action–informed approach, multidisciplinary working groups collaborated with organizational partners to review current inpatient observation practices. The Least Restraint Policy was revised, and an observation framework was developed. Updates emphasized least restraint principles, behavioural management strategies, documentation expectations, and escalation processes. PSA and VPO workflows were developed to guide in-person and virtual observation for patients with behavioural, cognitive, and fall-related risks. Implementation supports included education resources, communication tools, leadership engagement, and integration into orientation, email communication, intranet resources, and unit-based safety huddles.
Results
The initiative enabled organization-wide standardization of least restraint and observation practices, with clearer PSA role expectations and escalation pathways. Implementation of VPO expanded observation capacity. Education and workflows strengthened interdisciplinary communication and supported consistent application of least restraint, behavioural management, and fall prevention strategies.
Lessons Learned & Implications for Practice
Early implementation highlighted the importance of role clarity, staff education, and consistent observation processes. Integrating PSA and VPO practices within least restraint approaches supports patient-centred care through a structured framework for behavioural and safety monitoring across acute care settings.
Author(s) Credentials and Title
Amanda Aird, RN, BScN, MEd – Professional Practice Lead, Nursing
Jennifer Kasaboski, RN, BScN, MScN – Interprofessional Learning Specialist
Jennifer Cook, RN, BScN, CPMHN(C) – Clinical Learning Specialist
Briana Dube, RN, BScN, MSc (Aging and Health) – Clinical Learning Specialist
Tiffany Gingrich, RN, BScN, Program Manager, Mental Health & Addictions
Drew Conway, RN, BScN, Program Manager, Medicine Program
Contributors
Members of the Restraint Working Group and the Patient Safety Attendant/Virtual Patient Observation Working Group, including Program Managers, Clinical Learning Specialists, the QI & Innovation Lead, Patient Safety & Quality representatives, Recreational Therapy, and Occupational Health & Safety.
What RNAO BPG or tool/toolkit is your abstract related to?
Registered Nurses’ Association of Ontario (RNAO) Best Practice Guideline: Delirium, Dementia, and Depression in Older Adults: Assessment and Care
Registered Nurses’ Association of Ontario (RNAO) Best Practice Guideline: Preventing Falls and Reducing Injury from Falls
Registered Nurses’ Association of Ontario (RNAO) Best Practice Guideline: Promoting Safety: Alternative Approaches to the Use of Restraints
| Organization Name | Kingston Health Sciences Centre (KHSC) |
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