I support the article that appeared in the August issue of Nursing Management entitled "A S.A.F.E. Alternative to Sitters." The need for sitters, trained licensed and nonlicensed staff, family, or volunteers to help monitor and assist patients in the acute care setting continues to be a struggle. Incorporating the many aspects of running a successful business, including staffing, continuity of care, public perception, and most important, patient safety, can leave a team scratching their collective heads trying to find solutions.

In "A S.A.F.E. Alternative to Sitters," I found several excellent ideas that my facility could incorporate to enhance patient safety for the ever-growing population of patients who need constant observation. The S.A.F.E. unit is imperative for all facilities and a wonderful improvement to patient care. The use of the Sitter Blitz team to do performance improvement using the Plan-Do-Check-Act model helps address the potential abuses or misuses that could hinder the effectiveness of the S.A.F.E. unit. I also found the establishment of the preformatted orders (PFO) particularly useful. Having clear, legible guidelines for admission and discharge into the S.A.F.E. unit is a big timesaver for bedside nurses. PFOs that automatically trigger occupational or physical therapy evaluations and potential treatment plans are excellent means to streamline care, potentially decreasing the length of stay in the S.A.F.E. unit. The use of diversional activities, such as rocking chairs, stuffed animals, or folding linens, was insightful, patient specific, and could decrease risks associated with certain patient populations.

In closing, I would like to express my gratitude to Nursing Management for continuing to provide a forum for healthcare professionals to discuss new ideas that improve the quality and safety of patient-centered care.

Brian Melear, RN

Florida Atlantic University