Plymouth Community Healthcare CIC. Observation Policy ( Mental Health Wards and Plymbridge ) Version 2.3

Transcription

1 Plymouth Community Healthcare CIC Observation Policy ( Mental Health Wards and Plymbridge ) Version 2.3 Notice to staff using a paper copy of this guidance The policies and procedures page of Healthnet holds the most recent and approved version of this guidance. Staff must ensure they are using the most recent guidance. Author Modern Matron, Glenbourne Unit Asset Number 663 Page 1 of 27

2 Reader Information Title Observation Policy (Mental Health Wards and Plymbridge).v.2.3 Information Asset 663 Register Number Rights of Access Public Type of Formal Paper Policy Category Clinical Mental Health and Learning Disabilities Format Microsoft Word 2003 Language English Subject Observations within in-patients wards. Document Purpose and Description To provide clinical framework for observation within inpatient areas of Mental Health and Learning Disabilities Directorate, and in-patient Practice Facilitator Author Ratification Date and Group 30 th June 2011 Policy Ratification Group. Publication Date 24 th April 2015 Review Date Disposal Date Job Title of Person Responsible for Review Target Audience 30 th September 2015 Two years after publication, or earlier if there is a change in evidence. The policy ratification group will retain an e signed copy for the database in accordance with the Retention and Disposal Schedule, all previous copies will be destroyed. Modern Matron, Glenbourne Unit All clinical staff Electronic: Plymouth Healthnet and PCH website Circulation List Consultation Process Equality Analysis Checklist completed Written: Upon request to the Policy Ratification Secretary on Please note if this document is needed in other formats or languages please ask the document author to arrange this. In patient staff, medical staffing No Page 2 of 27

3 National Institute for Clinical Excellence The Short term management of disturbed / violent behaviour in inpatient psychiatric settings and emergency departments Clinical Guideline February References / Source Bowers L Goumay k, Duffy D Suicide and self harm in Inpatient Psychiatric units. A National Survey of Observation Policies ;Journal of Advanced Nursing; Volume Wyder M (2004) Understanding deliberate self harm: an enquiry into attempted suicide Supersedes Document Supportive Observation Policy v 2 By post: Local Care Centre Mount Gould Hospital Author Contact Details 200 Mount Gould Road Plymouth Devon PL4 7PY Tel: Fax: (LCC Reception) Page 3 of 27

4 Document Version Control Version Number 1 Details eg. Updated or full review New document Date 31/03/06 1:1 Updated 31/03/06 1:2 Updated 24/05/06 1:3 Reviewed 14/04/06 1:4 Updated 1:5 Updated August 2009 March Ratified June Updated July Extended September Extended April 2015 Author of Change Clinical Practice Facilitator Communications and Intranet Officer Clinical Practice Facilitator and Web Manager and FOI Officer. Clinical Practice Facilitator Modern Matron Modern Matron Policy Ratification Group. Modern Matron, Glenbourne Unit Modern Matron, Glenbourne Unit Modern Matron, Glenbourne Unit Description of Changes and reason for change New document To bring in line with Trust corporate standards Minor Changes Reviewed / No changes Minor changes Changes Minor typo s Updated Extended no changes Extended no changes Page 4 of 27

5 Contents of Observation Policy (Mental Health Wards and Plymbridge). Page 1 Introduction 6 2 Purpose 6 3 Definitions 6 4 Duties and Responsibilities 7 5 Levels of Observation: 5.1 General Observation 5.2 Intermittent Observation 5.3 Continuous Observation (within eyesight) 5.4 Continuous Close Observation( in arms length) 6 Principles of Supportive Observation: 6.1 Basic Principles 6.2 Delegation to Unregistered Staff 6.3 Review of Observation Status 6.4 Record Keeping Audit 14 8 Training Implications 14 9 Monitoring Compliance and Effectiveness Associated Documentation Lead Director Signature 15 Appendix A Intermittent Observation Chart 16 Appendix B 1 : 1 within eyesight / arms length close observation 17 Appendix C Appendix D Appendix E Hourly Observation for Acute In-patient Wards: Bridford, Harford, Edgcumbe and Cotehele Observation for Lee Mill: (Hourly from 7 am to Midnight and two hourly at night) Four Hourly Observation for Recovery In-patient Wards: Greenfields and Syrena Appendix F Practice Guidance 23 Appendix G Audit tool for observation charts 25 Appendix H Questions for Staff: Understanding the Enhanced 26 Engagement and Observation Policy Page 5 of 27

6 Observation Policy (Mental Health Wards and Plymbridge). 1. Introduction 1.1 Observation is an integral part of a therapeutic plan over a 24 hour period. The purpose of observation is to ensure the sensitive monitoring of the patient s behaviour and mental state, enabling a rapid response to any change, whilst at the same time fostering positive therapeutic relationships. This may be achieved by establishing good rapport with patients, promoting their coping skills and being aware of their individual needs. 1.2 The aim of this policy is to secure therapeutic engagement between clinical staff and patients. The policy provides a framework for general observation and heightened levels of observation when patients are considered to be at risk of harm to themselves or clinically indicated that they need a higher level of observations. An example of this could be, patients who are at risk of a fall or have significant physical issues. All levels of observation set out in this policy require that the prescribed level of observation is carried out whether or not the patient is asleep and the nurse must assure themselves at every observation interval that the patient appears to be breathing. This can be assessed in a variety of ways and will be dependent on the individual service user. 1.3 The forms in Appendix A and B should be completed at prescribed intervals and must be signed at the time of the observation, not at an earlier or later time. All parts of the forms must be completed and filed in the patient s multidisciplinary notes. 2. Purpose 2.1 The policy is to guide staff in the implementation of observation within an in-patient setting 3. Definitions 3.1 MDT Multi Disciplinary Team - a group of multi professional staff who are involved in the treatment of the service user. 3.2 POS - Place of Safety - the place of safety for detainees arrested on section 136 which is based at Glenbourne. Page 6 of 27

7 4. Duties and Responsibilities 4.1 The policy was devised by Matrons of in-patient units within NHS Plymouth. 4.2 The Chief Executive is ultimately responsible for the content of policies and their implementation. 4.3 Directors are responsible for identifying, producing and implementing NHS Plymouth policies relevant to their area. 4.4 Assistant Directors will support and enable operational Clinical Leads and Managers to fulfil their responsibilities and ensure the effective implementation of this policy. 4.5 The Ward / Unit Manager is responsible for ensuring the policy is in place and all Staff adhere. 4.6 All clinical staff who undertake observations are responsible for ensuring they adhere to this policy. 5. Levels of Observation 5.1 General Observation General observation is the minimum acceptable level of observation for all inpatients. The nurse in charge, if unable to undertake these checks must allocate a staff member, to undertake these observations. It is good practice to be aware of the locations of patients at all times however, this may vary within each unit. The levels of observation have been agreed as follows and this must be over a 24 hour period. Appendix C Hourly Observation for Acute In-patient Wards: Bridford, Harford, Plymbridge, Edgcumbe and Cotehele Appendix D One / Two Hourly Observations: this will apply to Lee Mill Hospital. Appendix E Four Hourly Observations: this will apply to Syrena and Greenfields The location of all patients should be known to staff, but all patients need not be kept within sight. On an agreed basis (see above) the Nurse in charge or their delegated deputy must observe the whereabouts of all in-patients and record on Appendix C. Page 7 of 27

8 5.2 Intermittent Observation A registered health professional can and should initiate intermittent when necessary and clinically indicated, 1:1 observations or increase the level of observation as appropriate, this must be with discussion with the nurse in charge, and will communicate with the Consultant Psychiatrist at the earliest opportunity. This level of observation is appropriate when patients are potentially, but not immediately at risk. This can include risks such as self harm, falls, AWOL, etc. Observation must be carried out on a 24 hour basis. Patients on intermittent observation must have a care plan that clearly indicates: The intervals at which the observation should be carried out (e.g. at 5 minute, 10 minutes etc. intervals) The nature of the therapeutic activity planned The need for a mental state assessment on each shift A record of any untoward incident The staff member responsible for the observations will be required to write a summary of the patient s presentation on the observation chart on an hourly basis. It is acceptable to write that summary following the hour, however, clinical judgement may indicate that a summary every fifteen minutes is more appropriate. This observation chart will then form part of the service user record. There is still a requirement to record an entry in the daily records after each shift, however the hourly summary will form the basis of the daily record. The person allocated to undertake the observations should be identified at the beginning of each shift, in exceptional circumstances when that person is unable to complete their allocated hour, there should be a different staff member allocated, this must be recorded on the observation sheet including the time they handed the observation over and who they handed over to. The record must include details of changes in mental state, physical, psychological and social behaviours, pertinent developments and significant events. All staff on the shift should be consulted prior to the completion of this summary to ensure accurate and complete information is documented. 5.3 Continuous 1:1 within eyesight observation A registered health professional can and should initiate intermittent, continuous and close observation or increase the level of observation as appropriate, and will communicate with the Consultant Psychiatrist at the earliest opportunity. Page 8 of 27

9 It is worth noting that individuals who have survived a suicide attempt, reported thinking about their actions for 10 minutes or less (Wyder 2004). This appears to be significantly affected by drugs or alcohol. Therefore patients at risk of suicide should be considered for 10 minute, 5 minute or continuous observations. Reasons for choice of particular observations should be documented in notes. This level of observation must be carried out on a continuous basis. 1:1 within eyesight observation is required when the service user is clinically considered at risk, e.g. falling, self harm. The service user will be kept within sight of and be accessible to observing staff at all times, by day and by night. Accessible for this level of observation means, if required you are able to position yourself within arms length immediately. If a service user is considered to be of high risk of self harm or suicide staff must consider actions such as removing high risk objects, e.g. shoe laces, belts etc. Consideration must also be given to ensure that staff are able to observe the service user e.g. requesting that they do not cover their neck. The staff member responsible for the observations will be required to write a summary of the service user s presentation on the observation chart (Appendix B). The person allocated to undertake the observations should be identified at the beginning of each shift, in exceptional circumstances when that person is unable to complete their allocated hour, there should be a different staff member allocated, this must be recorded on the observation sheet including the time they handed the observation over. This observation chart will form part of the entry to be made in the daily records section of the multi-disciplinary team (MDT) notes at the end of every shift This must include details of changes in mental state, physical, psychological and social behaviours, pertinent developments and significant events. All staff on the shift should be consulted prior to the completion of this summary to ensure accurate and complete information is documented. 5.4 Continuous 1:1 within eyesight / arms length observation A registered health professional can and should initiate intermittent, continuous and close observation or increase the level of observation as appropriate, and will communicate with the Consultant Psychiatrist at the earliest opportunity. This level of observation must be carried out on a continuous basis. 1:1 within arms length will be applied when a service user is considered to be in need of the very highest level of observation i.e. the service user is considered to be at a high risk, and will need to be nursed within arms length, with due regard to safety, privacy, dignity, gender and environmental dangers. A care plan is required. The staff member responsible for the observations will be required to write a summary of the service users presentation on the observation chart. The person allocated to undertake the observations should be identified at the beginning of each shift, in exceptional circumstances when that person is unable to complete their allocated hour, there should be a different staff member allocated, this must be recorded on the observation sheet including the time they handed the observation over. Page 9 of 27

10 This observation chart will form part of the entry to be made in the daily records section of the multi-disciplinary team (MDT) notes at the end of every shift (as a minimum) This must include details of changes in mental state, physical, psychological and social behaviours, pertinent developments and significant events. All staff on the shift should be consulted prior to the completion of this summary to ensure accurate and complete information is documented. 6. Principles of Observation Intermittent, 1:1 within eyesight observation and 1:1 at arms length observations will be carried out using the principles listed below. 6.1 Basic Principles Service users on enhanced observations, i.e. intermittent observations, 1:1 within eyesight observations; 1:1 at arms length observations must have their status reviewed once every twenty four hours. The health professional responsible for carrying out the observation must: Ensure that observations are carried out by the ward members this task cannot be delegated to family members or people from out the MDT team. Ensure that a safety check is conducted on the service user s room and associated day areas and potential hazardous objects removed. It may be considered necessary to search the service user and their room for concealed items Staff will be expected to adhere to the Searching of Property or Person policy V.1. For example it may be necessary to remove belts, tights, shoe laces and sharp objects The clinical rationale and decision not to remove such items must be recorded in the patient record. Ensure that the service user who is on intermittent or 1:1 observations should remain on the ward. If the service user leaves the ward they must be accompanied at all times by a competent member of staff. The member of staff must ensure they comply with the observation policy and are responsible for the documentation and the safe return of the service user to the ward. In the case of a service user who is on any level of observations (not including general) who attends a group, or therapy activity off the ward there must be consideration to the staff required to facilitate the group and to comply with the requirements of the observation. Service users on intermittent observations on the ward will remain subject to continuous observation by a competent member of staff whilst in the occupational therapy department or any area that is off the ward The safety of the service user and the need for therapeutic sessions will be discussed and agreed jointly with therapy and nursing staff during daily planning Page 10 of 27

11 meetings and care/ treatment planning. Should observation levels adjust at any time all members of the multidisciplinary team must be informed and re-convene to review the individuals changing needs, thus enabling wherever possible, planned therapeutic activities to take place. Depending on need and if staffing levels permit, a service user requiring continuous observation will be offered individual sessions on the ward or within the therapy department, or could attend specific group sessions. Groups will require appropriate staffing with one delegated staff member observing the actions and whereabouts of the individual throughout the session. The therapy team would endeavour to support this if staffing levels allow and there may be occasions when group therapy sessions cannot be facilitated. There must always be a robust verbal handover from therapy department to ward and ward to therapy department, which will support the exchange of required paperwork on which to record the observation process. Ensure in only exceptional circumstances the service user who is on intermittent or 1:1 observations will be allowed to leave the unit. This must be following an MDT discussion which is incorporated within the care plan. Exceptions to this, e.g. would include if the person requires urgent medical treatment. Be a Health professional, Student Nurse or unregistered health professional who is deemed to be competent by the Nurse in charge. (See section 6.2. Delegation to unregistered staff.) Know the service user, their history, background and risk factors Be familiar with the ward, the ward policy for emergency procedures and the potential risks within the environment. Be familiar with the observation care plan. Issues such as how toileting / personal hygiene activities are to be supervised must be specified. Ensure the service user is informed of the reasons for supportive observation or record why the reasons were not shared with the patient. Ensure where necessary, the service user should be offered a copy of the observation care plan translated into their own language. Ensure where disagreement exists with regard to the level of observation required by the service user, the higher level of observation will prevail until the resolution of differences takes effect. Be aware that the consultant and Ward Manager will jointly take responsibility for resolving differences however if they are unable to reach a consensus decision the Matron should be consulted. Page 11 of 27

12 Be aware that no period of observation by a member of staff will last longer than one hour, except in exceptional circumstances. At the end of each observation period, the nurse will have a break from each observation of at least half an hour. 6.2 Delegation to Unregistered Staff The registered nurse remains accountable for the decision to delegate observation to a health professional or student in training, and for ensuring that they are sufficiently knowledgeable and competent to undertake the role. They must ensure that the unregistered staff member is aware of the policy and has had an opportunity to discuss any aspects of the policy. There must be a record kept in the staff member s file which demonstrates that the person has read and understands the policy. Following this staff may use the practice guidelines to ensure that they regularly review the components of the policy. Competency can be measured by completing questions (Appendix H) and by being observed. Competency must be assessed before delegating observations. 6.3 Review of Observation Status Reduction of 1:1 observations The Consultant and the Ward Manager or their named deputy will be responsible for this review. The Consultant is able to do this review after consultation with the team on their own however the Ward Manager or their named deputy can not reduce 1:1 on their own. Any service user on 1:1 observations must be regraded to a minimum of 15 minutes intermittent observations for a minimum period of 24 hours before moving to general observations. 5 minute and 10 minute observations should also be considered particularly where patient has suicidal thoughts. Reasons for not regarding to 5 or 10 minute observations should be documented. If the Consultant is not available then this review must take place on the next working day. Junior or ward doctors can not review 1:1 observations. Reasons for discontinuing 1:1 and reasons for choice of alternative observations should be recorded in patient records. Reduction of intermittent observations Decisions to reduce the intermittent level of observation can be reduced in two ways: Jointly by the service user s Consultant Psychiatrist / Named Deputy (can be the Ward Doctor or Junior) and the first level Registered Nurse in charge of the ward, or Page 12 of 27

13 in the absence of a consultant psychiatrist a band 6 nurse can after consultation with the team reduce the level of observations. (This applies to Glenbourne only). This decision must be recorded in the service user s record, the current observation chart discontinued and filed. 6.4 Record Keeping All decisions regarding observation will be recorded in the Patient record. Records should include: The service user s mental state An assessment of the current level of risk and rationale for reduction of observation The specific level of observation to be implemented Clear directions regarding the therapeutic input within the observation period. Any changes to a service user s level of observation must include an assessment of their risk using the CPA risk assessment document A detailed record of the observation must be kept by participating staff. This must include: The name of the person responsible and the times they commenced and concluded their period of observation. This should be recorded on the observation form. A record of the service user s behaviour and mental state at specified intervals. There must be an hourly summary recorded on the observation sheet. Observation may involve a number of nurses, with care being handed over at hourly intervals. Excellent communication among staff must be maintained. A handover will take place at the beginning of each shift, of all staff to be involved in observing a service user, during which the service user s mental state is reviewed, potential dangers enumerated and attitudes to the process discussed. The nurse in charge of the ward is responsible for organising this briefing. There will be a handover and the completed record from the previous hour to the staff member who would be commencing the observation. If any changes are made to the circumstances of the observation such as a change in time intervals of checks, a new observation chart must be started and the details of the change must be recorded in the multidisciplinary notes. Page 13 of 27

14 All service users must have an inpatient care plan regarding their level of enhanced observations. The care plan must include: The specific level of observation required Any risk factors associated with undertaking the observations Interventions that will promote privacy and dignity for the service user The impact on the service user whereabouts whilst on enhanced observations A clearly recorded review time Full involvement of the service user and their clear understanding of the implications of enhanced observations. 7. Audit On a six monthly basis the Matrons will audit all observation records using the audit tool (Appendix G). The observation records should be reviewed by the ward manager on a regular basis as agreed by the ward manager and Matron. 8. Training Implications 8.1 All staff involved in undertaking observations must receive appropriate and relevant training. This includes a working knowledge of the operational policy and associated paperwork. 9. Monitoring Compliance and Effectiveness The observation forms should be routinely monitored by the Matron as above 10. Associated Documentation Impact assessment form CPA policy version 1 Searching Property or Person policy version 1 Page 14 of 27

15 All policies are required to be electronically signed by the Lead Director (the policy will not be accepted onto Healthnet until the e-signature is received). The proof of signature for all policies is stored in the policies database. The Lead Director approves this document and any attached appendices Signed: Dave McAuley, Locality Manager Central and North East Date: 1 August 2013 Page 15 of 27

16 Time checks Initials Intermittent Observation Chart Appendix A Patient s Name NHS Number: Date: Ward: Room No: Reason for Observations: Interval time: minutes Person allocated Location Summary of presentation to be completed hourly by nurse undertaking observations. (e.g. tearful but able to engage, appears agitated toward staff) Signatures Signature 1: I confirm that I have read the policy and accept responsibility for these checks. I confirm that I am the Nurse in charge of the Ward and have deemed this person competent and have delegated the checks to them Observation Policy v2.1 Page 16 of 27

17 Time checks initials Appendix B 1:1 Within eyesight / arms length close observation (delete as appropriate) Patient s Name Date: NHS Number: Ward: Reason for Observations: Person Allocated Location Observations by nurse doing hourly checks (e.g.. tearful but able to engage, appears agitated toward staff) Signatures: Name: Signature1: Signature 1: I confirm that I have read the policy and accept responsibility for these checks. I confirm that I am the Nurse in charge of the Ward and have deemed this person competent and have delegated the checks to them Observation Policy v2.1 Page 17 of 27

18 Appendix C Hourly Observation for Acute In-patient Wards: Bridford, Harford, Edgcumbe, Cotehele, Plym Bridge (delete as appropriate) Nurse in Charge - Print Name and Sign: am pm Date: Room Name 07:00 08:00 09:00 10:00 11:00 12:00 13:00 14:00 15:00 16:00 17:00 18:00 19:00 Member of staff allocated Signature 1: I confirm that I have read the policy and accept responsibility for these checks. Signature 2 I confirm that I am the Nurse in charge of the Ward and have deemed this person competent and have delegated the checks to them Key A Absent without leave G - Garden L On Leave OW Off Ward W On Ward All levels of supportive observation set out in this policy require that the prescribed level of observation is carried out whether or not the patient is asleep and the nurse must assure themselves at every Notes observation interval that the patient appears to be breathing. Observation Policy v2.1 Page 18 of 27

19 Nurse in Charge - Print Name and Sign: Room Name 20:00 21:00 22:00 23:00 24:00 01:00 02:00 03:00 04:00 05:00 06:00 Date: Member of staff allocated Signature 1 I confirm that I have read the policy and accept responsibility for these checks. Signature 2 I confirm that I am the Nurse in charge of the Ward and have deemed this person competent and have delegated the checks to them Key A Absent without leave G - Garden L On Leave OW Off Ward W On Ward Notes All levels of supportive observation set out in this policy require that the prescribed level of observation is carried out whether or not the patient is asleep and the nurse must assure themselves at every observation interval that the patient appears to be breathing. Observation Policy v2.1 Page 19 of 27

20 Observation for Lee Mill: (Hourly from 7 am to Midnight and two hourly at night) Appendix D Nurse in Charge Print Name and Sign: am pm Date: Room Name 07:00 08:00 09:00 10:00 11:00 12:00 13:00 14:00 15:00 16:00 17:00 Member of staff allocated Signature 1 I confirm that I have read the policy and accept responsibility for these checks. Signature 2 I confirm that I am the Nurse in charge of the Ward and have deemed this person competent and have delegated the checks to them Key A Absent without leave G - Garden L On Leave OW Off Ward W On Ward Notes Appendix D All levels of supportive observation set out in this policy require that the prescribed level of observation is carried out whether or not the patient is asleep and the nurse must assure themselves at every observation interval that the patient is appears to be breathing. Nurse in Charge - Print Name and Sign: Date: Observation Policy v2.1 Page 20 of 27

21 Room Name 18:00 19:00 20:00 21:00 22:00 23:00 24:00 02:00 04:00 06:00 Member of staff allocated Signature 1 I confirm that I have read the policy and accept responsibility for these checks. Signature 2 I confirm that I am the Nurse in charge of the Ward and have deemed this person competent and have delegated the checks to them Key A Absent without leave G - Garden L On Leave OW Off Ward W On Ward Notes All levels of supportive observation set out in this policy require that the prescribed level of observation is carried out whether or not the is patient is asleep and the nurse must assure themselves at every observation interval that the patient is alive and can be seen to breath unobstructed and without difficulty. Observation Policy v2.1 Page 21 of 27

22 Four Hourly Observation for Recovery In-patient Wards: Greenfields + Syrena Appendix E Nurse in Charge Print Name and Sign: am pm night Date: Room Name Surname 07:00 11:00 15:00 19:00 23:00 03:00 Member of staff allocated Signature 1 I confirm that I have read the policy and accept responsibility for these checks. Signature 2 I confirm that I am the Nurse in charge of the Ward and have deemed this person competent and have delegated the checks to them Key A Absent without leave G - Garden L On Leave OW Off Ward W On Ward Notes All levels of supportive observation set out in this policy require that the prescribed level of observation is carried out whether or not the is patient is asleep and the nurse must assure themselves at every observation interval that the patient appears to be breathing. Observation Policy v2.1 Page 22 of 27

23 Practice Guidance Appendix F All staff must be familiar with the supportive observation policy. They must also know the service user, their risks and rationale for the observations and the care plan. General supportive observations will be undertaken: Hourly at Glenbourne, Plymbridge, Edgcumbe and Cotehele Hourly (daytime) and two hourly (night times) at Lee Mill Four hourly at Greenfields and Syrena The Observation record must identify the staff member allocated. Signatures of the staff who undertake the observation and the nurse in charge responsible must be completed on the form. Any service users on 1:1 or intermittent observations must not be allowed to leave the ward unescorted. The person responsible for the escort must return the service user complete the documentation and hand over to the staff member identified to continue the observations. In exceptional circumstances the service user who is on intermittent or 1:1 observations will be allowed to leave the unit. This must be following an MDT discussion which is incorporated within the care plan. All observations must have a specific care plan. The observation record must identify; The interval at which observations must be carried out The location of the service user An hourly summary of the service user presentation. This will be completed by the staff member responsible for the observations The staff member responsible for the observation and the nurse in charge responsible for the unregistered staff must both sign the observation record. An entry must be made in the daily records at the end of every shift. The summary on the observation chart will form part of the entry to the daily record 1 : 1 Observations and intermittent observations will be reviewed every 24 hours by the ward manager or their nominated deputy and Consultant and the review recorded in the patient notes A registered nurse can and should initiate observations and can increase level as appropriate Observation Policy v2.1 Page 23 of 27

24 Reduction of 1:1 observations The Ward Manager or their named deputy and the Consultant will be responsible for this review. Any service user on 1:1 observations must be regraded to a minimum of 15 minutes intermittent observations for a minimum period of 24 hours. Reasons for not regarding to 5 or 10 minute observations should be documented. Reduction of intermittent observations Decisions to reduce the intermittent level of observation can be reduced in two ways; jointly by the service user s Consultant Psychiatrist / Named Deputy and the first level Registered Nurse in charge of the ward, or in the absence of a consultant psychiatrist a band 6 nurse can after consultation with the team reduce the level of observations.( this applies to Glenbourne only) No period of observation will be longer than one hour, except in exceptional circumstances. There should be a break of ½ hour from each observation. Any breach of the observation policy must be reported to the ward manager. Observation Policy v2.1 Page 24 of 27

25 Audit tool for Observation Charts Appendix G Ward / Unit: Date: Yes / No 1 Was the patient s name completed? 2 Was the NHS Number recorded? 3 Was there a care plan identifying the observation level? 4 Was the date of observation completed? 5 Was the ward identified? 6 Were the reasons for observation completed? 7 Was the interval time recorded? 8 Was the person allocated box completed? 9 Were the time checks recorded? 10 Was the activity recorded? 11 Was the summary of presentation recorded? 12 Did the summary demonstrate a clear representation of the patient? 13 Were there two signatures for each hourly allocation of observation? 14 Does the entry into the daily record correspond with the observation chart? Comments / Action Plan Signed Print Name The results of this audit must be fed back to Locality Managers Observation Policy v2.1 Page 25 of 27

26 Questions for Staff: Understanding the Enhanced Engagement and Observation Policy (You must have completed this sheet yourself with your line manager before testing others) Appendix H Staff Member s Name Date 2013 Temporary Staff 1) If a patient is on 1:1 due to suicidal risk what items should they not have on their person or in their room? 2) What is the difference between arm s length and eye sight observations? 3) What are the various levels of intermittent observations? 4) What should you tell the patient (verbally and written) who is receiving observations? 5) If you were unable to complete your observations on time what should you do? 6) If you needed to swap with a member of staff your assigned observations, what should you do? 7) What are your responsibilities regarding a patient on enhanced observation who wants to go to the garden, O.T dept? what if 2 patients wanted to go out at the same time? 8) What should you be observing when the patient appears asleep / during the night? 9) How would you know that you have been allocated observations to be done? 10) What would you do if you noticed another member of staff was not completing their observations? Ward permanent staff additional questions to be answered 11) How often should observations be reviewed, and by whom? 12) How would you manage a ward where there were more than 5 patients on observations? 13) What should you think about if a patient has been put onto 1:1 observations with regards to staffing? Observation Policy v2.1 Page 26 of 27

27 Do you feel confident that the member of staff has an accurate understanding of how to complete safe observation from their answers above? Yes No Signature Grade Date Actions Observation Policy v2.1 Page 27 of 27