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J Adv Nurs. 2008 Oct;64(2):176-83. doi: 10.1111/j.1365-2648.2008.04779.x.

Effective assessment of use of sitters by nurses in inpatient care settings.

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Division of Nursing Business and Health Systems, School of Nursing, The University of Michigan, Ann Arbor, Michigan, USA.



This paper is a report of the evaluation of the impact of adopting the Patient Attendant Assessment Tool (PAAT) on nurses' requests for sitters, use of restraints, and falls and fall injury rates.


Staffing should be the primary issue in eliminating risks of patient falls during hospital stays.


Data were collected in two acute adult medical units of a Michigan hospital from August 2005 to February 2007. Data from three sources were merged for analyses: (1) study units' monthly reports; (2) quarterly reports of the National Database of Nursing Quality Indicators and (3) PAAT reports collected from October 2006 to February 2007. The primary outcome variables were the use of sitters, number of restraints ordered and fall and fall injury rates. Independent t-tests and correlation analyses were used for data analyses. The data before and after adopting this tool were compared using independent t-tests.


The PAAT helped improve the fill/request rates for sitters. The use of soft limb holders decreased after adoption of this tool. The results also showed that if the number of sitter requests was higher, the total number of restraints would be lower but the total fall rate would be higher.


Hospitals should include a tool similar to the PAAT in guidelines related to provision of constant observation or use of sitters. Further investigations of the optimum combination of staffing patterns and infrastructure are needed to promote safer hospital stays.

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