mental health & learning disabilities in … supportive...page 1 of 26 mental health inpatient...

of 26 Mental Health Inpatient Supportive Observation Policy Version No. 8.0

MENTAL HEALTH & LEARNING DISABILITIES IN-PATIENT SUPPORTIVE

OBSERVATION POLICY

Document Author Authorised

Written By: Clinical Quality and Safety Lead - Acute Mental Health Services. Date: May 2016

Authorised By: Chief Executive Date: 14 June 2016

Lead Director: Clinical Director – Mental Health Business Unit.

Effective Date: 14 June 2016

Review Date: 13 June 2019

Approval at: Policy Management Group

Date Approved: 14 June 2016


DOCUMENT HISTORY (Procedural document version numbering convention will follow the following format. Whole numbers for approved versions, e.g. 1.0, 2.0, 3.0 etc. With decimals being used to represent the current working draft version, e.g. 1.1, 1.2, 1.3, 1.4 etc. For example, when writing a procedural document for the first time – the initial draft will be version 0.1)

Date of Issue

Version No.

Date Approved

Director Responsible for

Change

Nature of Change Ratification / Approval

Oct 12 5.1 Clinical Director Draft in line with NHSLA requirements

1 Nov 12 5.2 Agreed at Quality & Patient Safety Committee with amendments

14 Dec 12 5.3 Agreed at Policy Management Group with amendments

17 Dec 12 6 17 Dec 12 Clinical Director, Community Health

Approved at Executive Board

Nov 13 7 Clinical Director, Community Health

Amendments to reference risk indicators, inclusion of specific observation levels for rehabilitation service and standardised recording documentation for all areas.

Approved at Mental Health Quality and Risk Group

Dec 13 7 13 Feb 14 Clinical Director, Community Health

Updated with amendments

Approved at Clinical Standards Group

18 Mar 14 7 18 Mar 14 Clinical Director, Community Health

Updated with amendments

Approved at Policy Management Group

11 May 15 7.1 Draft Only Updated and amendments

Working draft only

02 Dec 15 7.2 Clinical Director Mental Health

Updated and amendments

29 Apr 16 7.3 Clinical Director Mental Health

For ratification of reviewed and amended policy

Clinical Standards Group

10 May 16 8 14 Jun 16 Clinical Director Mental Health

For Approval Policy Management Group

NB This policy relates to the Isle of Wight NHS Trust hereafter referred to as the Trust


Contents Page

1. Executive Summary…………………………………………...... 4

2. Introduction……………………………………………………….. 4

3. Definitions………………………………………………………… 5

4. Scope……………………………………………………………… 5

5. Purpose…………………………………………………………… 5

6. Roles & Responsibilities………………………………………… 5

7. Policy Detail / Course of Action………………………………… 7

8. Consultation……………………………………………………… 11

9. Training…………………………………………………………... 11

10. Monitoring Compliance and Effectiveness…………………… 12

11. Links to other Organisational Documents…………………… 12

12. References……………………………………………………… 12

13. Appendices……………………………………………………... 13


1 Executive Summary Supportive observation is the process of engagement with a patient whose mental state has resulted in a risk of harm to self or others being identified. The purpose of engagement is to ensure safety of patient and others until risk has reduced.

2 Introduction By regularly assessing and identifying risk in relation to self harm and harm to others and people who are vulnerable, local immediate resources can be effectively utilised and planned. The aim of this is to ensure that

The safety of the person at risk and others are maintained

Privacy, dignity of people whilst under the care of inpatient units is promoted.

Collaborative relationships between service users and staff are developed

NICE (2005) and ‘Avoidable Deaths’ (2006) suggests that observation above general observation should be considered if any of the following warning signs are present and all must be considered in relation to each individual:

History of previous suicide attempts, self-harm or attacks on others

Hallucinations, particularly voices suggesting harm to self or others

Paranoid ideas where the patient believes that other people pose a threat

Thoughts or ideas that the patient has about harming themselves or others

Past or current problems with drugs or alcohol

Recent loss or significant life event

Poor adherence to medication programmes or non-compliance with medication programmes

Marked changes in behaviour or medication

Known risk factors.

Chronic physical health problems, especially in older people

High levels of impulsivity

High levels of hopelessness.

Significant levels of agitation.

When a person is unknown to services and is presenting for the first time in acute mental health crisis.


Physical health issues must be considered too, because either alone, or in combination with mental health problems, they may indicate the need for increased observation. Some of the conditions that may present increased risks to the patient’s well being are:

Coronary heart disease

Diabetes

Asthma

Blood pressure irregularities

Mobility problems

Head injury

Side effects of medication

3 Definitions Shift co-ordinator – Registered nurse or Mental Health Practitioner in charge of the shift.

4 Scope This policy applies to all Isle of Wight NHS Trust staff (including agency and locum staff) involved in the care and management of patients within the Mental Health Acute Care Pathway.

5 Purpose To provide a framework that assists mental health practitioners to identify level of supportive observation for all mental health inpatients within all areas of the Mental Health and Learning Disabilities service.

6 Roles and Responsibilities 6.1 Admitting Doctor and Nurse

On admission the patient will be assessed jointly by the admitting doctor and registered nurse on duty. If for any reason this joint assessment does not occur a minimum of Level 2 (15 min observations) will be put in place until a full nursing and medical review. The admission assessment must include a discussion regarding the appropriate level of nursing observations needed.

Whenever possible and when appropriate this discussion should also take into account the views of the patient’s family, friends and carers.

The agreed level of observations will be documented within the PARIS case notes with a clearly stated rationale for the level agreed. This documentation will also note who was involved in the discussion i.e. Staff, patient, family, friends or carers.


6.2 Qualified practitioner allocated to patient

Where appropriate will discuss with other practitioners, and collect current information that will help in formulating risk.

Will agree with team level of observations indicated.

Will ensure that the assessment has been done and what action was implemented and that this has been recorded in patient’s notes.

Will ensure that this information is shared to rest of team especially at handover.

6.3 Shift co-ordinator

Will facilitate a handover which includes physical sight of patients between the incoming and outgoing shifts. This task can be delegated to registered nurses on both shifts.

Will delegate staff and allocate the observer utilising resources appropriately and ensure that staff undertaking observations understand what the risk concerns are and what is expected of them.

Will discuss any divergence with area manager.

6.4 Observer

Will undertake observation as directed by ‘Shift coordinator’.

Will ensure that they have received a full handover of current risks to the patient prior to undertaking any observations.

Will seek clarity from Shift coordinator if there is uncertainty of their role and responsibilities.

Will record the observations on the appropriate recording form (Appendices A-F) and ensure that this is filed in the persons health care records when complete.

6.5 The Team Manager

Will ensure that written information regarding the therapeutic observation and engagement of patients is available for patients, their family, friends and carers in the ward area.

Will formally audit and propose amendments of the use of supportive observations yearly of records held locally for monitoring purposes.

Will bring to the attention of the MH&LD Business Unit Board any immediate concerns relating to supportive observation through their line manager.

Will address non concordance with this document in a three stage process

Initially through supervision, if not resolved then

Progressing to the Appraisal process if concordance is still a concern then

Finally through the implementation of the organisations capabilities process through the Capability Policy and Procedure.


7 Policy detail/Course of Action 7.1 General Principles and course of action

All levels of observations can be applied to patients detained under the Mental Health Act 1983 without their consent, although such consent must always be sought. Even if the patient declines consent, this procedure is applicable to them. They retain the right to ask for a review of the observation to which they are subject.

All levels of observation may be applied to informal patients without their explicit permission, even though permission must always be sought. If the patient objects to the observation that they are placed on, the multidisciplinary team should consider the objection. Patient safety is paramount in all decision making. Patients admitted informally to an inpatient facility who are assessed as lacking capacity may be treated under ‘best interests’ in the context of the Mental Capacity Act (2005). The appropriate assessment of capacity will need to be completed. They retain the right to ask for a review of the observation to which they are subject.

All levels of observation are an opportunity to engage with patients and must not be regarded as just another task to be recorded. Research demonstrates that risk of suicide is reduced when a patient is given the opportunity to talk about their distressing thoughts.

The primary aim of observation should be to engage positively with the patient (NICE 2005). Care environments that provide high therapeutic interventions, based on a strong culture of staff and patient engagement reduce risk, disturbance, aggression, violence and boredom. As a result they are safer and more positive environments for people receiving care and for staff providing the care (Bowers et al 2008).

Observations cover the 24 hour period. This includes times when patients may be sleeping or resting. The policy requires staff to observe patients in their bedrooms to check on the physical and mental well being of patients and to ensure the patient is breathing. This may mean that the nurse undertaking the observations will need to enter the patient’s bedroom.

When reviews are undertaken and observations are reduced or discontinued, it will be fully noted in the person’s healthcare record. The risk assessment and management plan will be reviewed at each formal review.

The member of staff carrying out observations will report any untoward changes or concerns immediately to the nurse responsible for the care of the patient on that shift or, in their absence, the shift co-ordinator.

All staff carrying out observations will take into account the need to maintain the privacy, dignity and safety of the patient under observation and other people in the immediate area. Due consideration must be given to issues such as gender, culture, religion and age, when deciding who should undertake the supportive observations. There must be a specific plan in place to ensure that any persons on enhanced observations undertaking personal care i.e. toileting or bathing, have discussed with staff the method in which the observations will be carried out during that time


Any decisions to use increased supportive observations will be discussed and agreed with the team and where possible both professional and non professional carers at the earliest opportunity.

Increased levels of supportive observations will be reduced or discontinued as soon as the team feel the person has recovered to a level where they are no longer appropriate. This will be done in collaboration with the person and their carer.

Supportive observations should not be used: o as a substitute for appropriate staffing levels o no Psychiatric Intensive Care Unit bed o absconding that’s not associated with risk o as a punitive measure

It is best practice for supportive observations to be undertaken by the most experienced and established members of staff.

All new staff will undergo induction and training as detailed in the training and awareness section of this document prior to carrying out any supportive observations.

Staff will make due consideration of the appropriateness of the persons placement. If an increase in supportive observations is being considered, there may need to be a joint assessment with other inpatient wards carried out and a contingency plan should be made to manage risks should the situation deteriorate.

Any staff member carrying out observations should be aware of the person’s whole care and treatment plan to ensure the person needs are being met at all times. This may include activities off the unit accompanied by staff member or carer.

7.2 Principles and course of action specifically for Inpatient areas

All people being admitted to the unit have the right to a full risk assessment and management plan within 3 hrs of admission.

Person to be added to paper copy Normal Ward Observations list and noted on bed board.

It is acknowledged that for some people increased supportive observations may be required Throughout their inpatient stay due to ongoing need for one to one care. e.g. people with a disability/ people requiring palliative care/ older people.

Staff will not be expected to undertake 1-1 supportive observations for longer than 2 hours without a break as negotiated with the shift co-ordinator. It will be the decision of the shift co-ordinator how the observations will be managed at each handover. All staff on duty and the person to be made aware of level of observations by admitting nurse and a rationale for why observations are commenced at that level for each individual.

Shift Co-ordinators will allocate members of staff to carry out observations for that shift and ensure that the incoming Shift Co-ordinator is fully informed.


The person will be introduced to the designated staff member by the admitting nurse. Introduction to other team members will be carried out to all subsequent changeovers of staff throughout the shift.

7.3 Levels of Observation Level 1 – High level of nursing intervention where the person requires one-to-one support at all times. For example the person is:

High risk of severe self-harm/suicide

High physical needs such as a disability which may increase the risk to self or others

High level of vulnerability

Person requires high level of assessment as they are not known to service and present with unpredictable behaviour and/or threats to harm.

The care plan should stipulate whether the observations are eyesight or arms length of the patient. Level 2 – Intermittent Observations (5 – 30 minutes) where the person requires allocated member of staff to ensure privacy, dignity and safety needs are met through collaborative care planning.

Intermittent observations should be used when the risk assessment identifies that there is an increased risk and that the person requires more support than that of General Ward Observation (Level 3 hourly observations).

For example anyone:

1. previously on Level 1 observations 2. transferred from the Psychiatric Intensive Care Unit (PICU) to the open ward 3. following a critical incident 4. who would be deemed at risk of leaving the unit 5. with high physical health needs 6. starting a new treatment regime, detoxification etc.

These observations will be carried our intermittently as agreed by the Multi Disciplinary Team and the person.

The person will be assessed as being able to request support from staff and take an increased responsibility for their own care needs.

The staff member responsible for observations will be aware of factors which may contribute to deterioration and make an intermittent record of the person’s activities and report any changes to a qualified member of staff.

Level 3 – Normal Ward Observations – Staff will document hourly that the patient is present on the ward area. Daytime Observations 06.00hrs to 22.00hrs

On all mental heath wards/units, Level 3 (hourly) observations will be carried out as a minimum standard during daytime hours. Increased observations should be in place if the risk assessment dictates.


Night time Observations 22.00hrs to 06.00hrs

Afton, Osborne, Seagrove and Shackleton acute care wards will carry out Level 3 hourly observations throughout the 24 hour day for all patients present on the ward as a minimum standard. Increased observations should be in place if the risk assessment dictates.

Woodland Rehabilitations Unit will carry out 4 hourly observations as a minimum standard between the hours of 22.00hrs and 06.00hrs. The adoption of lower levels of observation must be subject to the ongoing and dynamic process of continually assessing risk both in terms of risk to self and risk to others.

Staff must be clear that in documenting on the observation charts that they have seen the patient either in their bedroom awake (BDA) or their bedroom asleep (BDS), that they have had eyesight of the patient and that they are breathing. This may require that the nurse undertaking the observations enters the patient’s bedroom. The observation level in use will be clearly stated in the patients care plan. Record keeping for all inpatient areas in relation to this document will be recorded on approved forms (See Appendices). 7.4 Responsibility for changing levels of observations: Increasing levels of observation:

Any registered nurse or Doctor.

The multidisciplinary team when reviewing care. Decreasing level 2 (intermittent) observations: Discussions must take place and include:

Ward Manager (when on duty)

Shift Co-ordinator

Other members of the MDT on duty

View of the patient

View of the family, friend or carer (where appropriate) Decreasing Level 1 (eyesight or arms length) observations: Patients who are placed on Level 1 observations are people deemed to be at the highest risk. Therefore reducing Level 1 observations must follow a formal process to ensure that a robust team decision is made which is based on current mental state and risk assessment whilst taking into account the views of the patient and carers. The objective of the decision reached is always to provide safe care whilst treating the patient in the least restrictive environment. Any patient subject to Level 1 (eyesight or arms length) observations will be reviewed at a minimum once in every 24 hours. A full MDT review will whenever possible include:

Ward Manager or Senior Nurse in the unit.


Shift co-ordinator.

Other members of the MDT, one of which must be a Doctor.

Views of the patient.

Views of the family, friend or carer (where appropriate).

All levels of Observations - When patient observation levels are increased or decreased:

A clear rationale for the decision should be recorded in the patient record.

The observation care plan is reviewed and amended.

The risk assessment and management plan is updated.

Electronic handover sheet is amended.

Patient board is amended.

Where appropriate the family, friend or carer will be informed.

7.5 Principles and course of action specifically for Crisis Resolution and Home Treatment Team Decisions and agreed actions about level of contact should be recorded in patient record by the allocated healthcare practitioner in a realistic and timely manner. The decision to decrease levels of contact will be made within daily MDT meetings. Where possible and appropriate any changes in level of contact will include discussion with the patient’s family, friend or carer. These discussions will be documented within the PARIS record.

Levels of Observation

High - Seen twice a day, risks include - deterioration due to high risk to self and others, social isolation, poor compliance and effects of prescribed medication, increased vulnerability (including adult or child protection).

Medium - Seen daily, risks include – as above but patient has been assessed as being able to maintain their personal safety and the patient has adequate carer or social support.

Low - Seen at least every three days incorporating discretionary telephone contact. Risk identified as low and patient is successfully recovering and has engaged in all therapeutic activities and is compliant with medication.

8 Consultation This document has been consulted on with all Mental Health Ward Managers and Team Leaders, Operational Managers, Clinical Director, Head of Nursing and Quality, the Trust Clinical Standards Group and received final approval at the Trust Policy Management Group.

9 Training This Mental Health & Learning Disabilities In-patient Supportive Observation Policy does not have a mandatory training requirement but the following non mandatory training is required:- A competency checklist will be completed at induction by new starters to acute care teams,


including nursing bank staff, and annually at appraisal for all substantive staff within Acute Mental Health services.

10 Monitoring Compliance and Effectiveness The Matron and Ward Managers will complete a bi-annual compliance audit. This will be reported to the Mental Health & Learning Disability Quality Group and any appropriate actions taken. This document will be referred to and its appropriate use reviewed during Serious Incident Reviews that have a particular reference to the supportive observations of service users in an in-patient setting.

11 Links to other Organisational Documents

Mental Health and Learning Disability Clinical Risk Policy

Trust Risk Management Strategy

Seclusion Policy

Privacy and Dignity Policy

Mental Health Code of Practice 1983

SNMAC Guidance on Supportive Observations

Detoxification Protocol

Learning Disabilities Intervention Policy

Department of Health (2010) Essence of Care 2010

Capability Policy and Procedure

Appraisal Policy

Business Continuity Plan

12 References Standing Nursing and Midwifery Advisory Committee (1999). Practice Guidance Safe and Supportive Observations of Patients at Risk Mental Health Nursing. “Addressing Acute Concerns”.

‘Avoidable Deaths’ Five year report of the national confidential inquiry into suicide and homicide by people with mental illness (2006) University of Manchester. Department of Health (2007) Best practice in managing risk – principles and evidence for best practice in assessment and management of risk to self and others in mental health services. Bowers L, Flood C, Brennan G & Allan T (2008) A replication study of the City nurse intervention: reducing conflict and containment on three acute psychiatric wards Journal of Psychiatric and Mental Health Nursing 15, 737-742. National Institute for Health and Clinical Excellence (2005) Violence: the short-term management of disturbed/violent behaviour in inpatient psychiatric settings and emergency departments. Clinical Guideline 25. London: NICE.


National Institute for Health and Clinical Excellence (2005a) Violence: managing disturbed/violent behaviour. Understanding NICE guidance – information for patients, their advocates, families and carers, and the public. London: NICE.

13 Appendices

Appendix A Seagrove Ward Hourly (Level 3) Supportive Observations Record Sheet Appendix B Osborne Ward Hourly (Level 3) Supportive Observations Record Sheet Appendix C Afton Ward Hourly (Level 3) Supportive Observations Record Sheet Appendix D Shackleton Ward Hourly (Level 3) Supportive Observations Record Sheet Appendix E Woodlands Rehabilitation Unit (Level 3) Supportive Observations Appendix F All Areas Intermittent Level 1 or 2 Supportive Observations Record Sheet Appendix G Financial and Resourcing Impact Assessment on Policy Implementation Appendix H Equality Impact Assessment (EIA) Screening Tool


APPENDIX A Seagrove Ward Hourly (Level 3) Supportive Observations Record Sheet KEY:

D/R DINING ROOM

W WARD AREA T TOILET B COMMUNAL BATHROOM

TV

TV LOUNGE G GARDEN LOUNGE/GAR

DEN

K KITCHEN BDA

BEDROOM AWAKE

BDS

BEDROOM

SLEEPING

M/C

MALE CONSERVATORY

F/C

FEMALE CONSERVATOR

Y

OT

OCCUPATIONAL THERAPY

CD

CALMDOWN ROOM

SEC SECLUSION L ON LEAVE

Date…………………………………

Room number and Patient Name 0

7.0

0

08.0

0

09.0

0

10.0

0

11.0

0

12.0

0

13.0

0

14.0

0

15.0

0

16.0

0

17.0

0

18.0

0

19.0

0

20.0

0

21.0

0

22.0

0

23.0

0

00.0

0

01.0

0

02.0

0

03.0

0

04.0

0

05.0

0

06.0

0

1.

2.

3.

4.

5.

6.

7.

8.

ECA

136

Observing Nurses initials

Patients on leave with no bed: Staff must be clear that in documenting on the observation charts that they have seen the patient either in their bedroom awake (BDA) or their bedroom asleep (BDS), that they have had eyesight of the patient and that they are breathing. This may require that the nurse undertaking the observations will enter the patient’s bedroom.


APPENDIX B Osborne Ward Hourly (Level 3) Supportive Observations Record Sheet KEY:

MK MALE KITCHEN

FK FEMALE KITCHEN

OT OCCUPATIONAL THERAPY

GWA GENERAL WARD AREA

ML MALE LOUNGE

FL FEMALE LOUNGE

FB FEMALE BATHROOM

MB MALE BATHROOM

LR LAUNDRY ROOM

IR INTERVIEW ROOM

ECT ECT SUITE BDS BEDROOM SLEEPING

BDA BEDROOM AWAKE

G GARDEN RA RECEPTION AREA

L ON LEAVE

Date…………………………………


7.0

0

08.0

0

09.0

0

10.0

0

11

.00

12.0

0

13.0

0

14.0

0

15.0

0

16.0

0

17.0

0

18.0

0

19.0

0

20.0

0

21.0

0

22.0

0

23.0

0

00.0

0

01.0

0

02.0

0

03.0

0

04.0

0

05.0

0

06.0

0

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

11.

12.

13.

Staff must be clear that in documenting on the observation charts that they have seen the patient either in their bedroom awake (BDA) or their bedroom asleep (BDS), that they have had eyesight of the patient and that they are breathing. This may require that the nurse undertaking the observations will need to enter the patient’s bedroom.


MK MALE

KITCHEN FK FEMALE

KITCHEN OT OCCUPATIONAL

THERAPY GWA GENERAL

WARD AREA

ML MALE LOUNGE

FL FEMALE LOUNGE

FB FEMALE BATHROOM

MB MALE BATHROOM

LR LAUNDRY ROOM

IR INTERVIEW ROOM

ECT ECT SUITE BDS BEDROOM SLEEPING

BDA BEDROOM AWAKE

G GARDEN RA RECEPTION AREA

L ON LEAVE


14.

15.

16.

17.

18.

19.

Temp. Bed

Observing nurses initials


Appendix C Afton Ward Hourly (Level 3) Supportive Observations Record Sheet KEY:

BDA BEDROOM AWAKE

BDS BEDROOM ASLEEP

K KITCHEN FL FEMALE LOUNGE

ML MALE LOUNGE

CA COMMUNAL AREA

OT OT CORRIDOR MG MALE GARDEN

FG FEMALE GARDEN

R RECEPTION WB WARD BATHROOM

AT ASSISTED TOILET

L ON LEAVE OUT OFF THE WARD

Date…………………………………


7.0

0

08.0

0

09.0

0

10.0

0

11.0

0

12.0

0

13.0

0

14.0

0

15.0

0

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0

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0

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0

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0

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0

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0

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0

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2.

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7.

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10

11.

12.


Patients on leave with no bed: Staff must be clear that in documenting on the observation charts that they have seen the patient either in their bedroom awake (BDA) or their bedroom asleep (BDS), that they have had eyesight of the patient and that they are breathing. This may require that the nurse undertaking the observations will need to enter the patient’s bedroom.


Appendix D Shackleton Ward Hourly (Level 3) Supportive Observations Record Sheet KEY:

GWA

GENERAL WARD AREA

MB MALE BATHROOM

FB FEMALE BATHROOM

AB ASSISTED BATHROOM

FL FEMALE LOUNGE

ML MALE LOUNGE

QR QUIET ROOM NP POD

BDA

BEDROOM AWAKE

BDS BEDROOM ASLEEP

DESC DEESCALATION L ON LEAVE

Date…………………………………


7.0

0

08.0

0

09.0

0

10.0

0

11.0

0

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0

13.0

0

14.0

0

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0

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0

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0

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0

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0

20.0

0

21.0

0

22.0

0

23.0

0

00.0

0

01.0

0

02.0

0

03.0

0

04.0

0

05.0

0

06.0

0

1.

2.

3.

4.

5.

6.

7.


Patients on leave with no bed: Staff must be clear that in documenting on the observation charts that they have seen the patient either in their bedroom awake (BDA) or their bedroom asleep (BDS), that they have had eyesight of the patient and that they are breathing. This may require that the nurse undertaking the observations will need to enter the patient’s bedroom.


Appendix E Woodlands Rehabilitation Unit (Level 3) Supportive Observations

K KITCHEN OT OCCUPATIONAL

THERAPY BDS BEDROOM

SLEEPING G GARDEN DR DINING ROOM OF OFFICE GY GYM DB DOWNSTAIRS

BATHROOM

LR LAUNDRY ROOM

GWA GENERAL WARD AREA

BDA BEDROOM AWAKE

L LOUNGE C CONSERVATORY OL ON LEAVE

UB UPSTAIRS BATHROOM

UO UPSTAIRS OFFICE

ROOM NUMBER AND PATIENT NAME

07.0

0

08:0

0

09.0

0

10.0

0

11.0

0

12.0

0

13.0

0

14.0

0

15.0

0

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0

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0

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0

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0

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2.

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7.

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9.

10.

11

OBSERVING NURSES INITIALS



APPENDIX F

All Areas Intermittent Level 1 or 2 Supportive Observations Record Sheet

Record Level 1 observations at 15 minute intervals. Record Level 2 observations at time of observation being undertaken.

Staff must be clear that when in documenting on the observations charts that they have seen the patient in their bedroom awake (BDA) or in their bedroom asleep (BDA), that they have had eyesight of the patient and that they are breathing. This may require that the nurse undertaking the observations will need to enter the patient’s bedroom.

Patient Name: Ward:

Date: Please circle observation level below

Level 1 (arms length) Level 1 (eyesight)

Level 2 – 5 minutes Level 2 – 10 minutes

Level 2 – 15 minutes Level 2 – 30 minutes

Level 2 – Other -

Time Nurses Name Comments Signature


Appendix G

Financial and Resourcing Impact Assessment on Policy Implementation

NB this form must be completed where the introduction of this policy will have either a positive or negative impact on resources. Therefore this form should not be completed where the resources are already deployed and the introduction of this policy will have no further resourcing impact.

Document title

Mental Health and Learning Disabilities Inpatient Supportive Observation Policy

Totals WTE Recurring £

Non Recurring £

Manpower Costs 0 0 0

Training Staff 0 0 0

Equipment & Provision of resources 0 0 0

Summary of Impact: Revision of existing Policy Within current staff induction programme – no additional costs Risk Management Issues: n/a

Benefits / Savings to the organisation: Increased assurance of patient safety during in-patient spell. Equality Impact Assessment Has this been appropriately carried out? YES Are there any reported equality issues? NO If “YES” please specify:

Use additional sheets if necessary. Please include all associated costs where an impact on implementing this policy has been considered. A checklist is included for guidance but is not comprehensive so please ensure you have thought through the impact on staffing, training and equipment carefully and that ALL aspects are covered.

Manpower WTE Recurring £ Non-Recurring £

Operational running costs

0 0 0

Totals: 0 0 0


Staff Training Impact Recurring £ Non-Recurring £

Totals: 0 0

Equipment and Provision of Resources Recurring £ * Non-Recurring £ *

Accommodation / facilities needed 0 0

Building alterations (extensions/new) 0 0

IT Hardware / software / licences 0 0

Medical equipment 0 0

Stationery / publicity 0 0

Travel costs 0 0

Utilities e.g. telephones 0 0

Process change 0 0

Rolling replacement of equipment 0 0

Equipment maintenance 0 0

Marketing – booklets/posters/handouts, etc 0 0

Totals: 0 0

0

Capital implications £5,000 with life expectancy of more than one year.

Funding /costs checked & agreed by finance:

Signature & date of financial accountant:

Funding / costs have been agreed and are in place:

Signature of appropriate Executive or Associate Director:


Appendix H

Equality Impact Assessment (EIA) Screening Tool

1. To be completed and attached to all procedural/policy documents created within individual

services.

2. Does the document have, or have the potential to deliver differential outcomes or affect in an adverse way any of the groups listed below? If no confirm underneath in relevant section the data and/or research which provides evidence e.g. JSNA, Workforce Profile, Quality Improvement Framework, Commissioning Intentions, etc. If yes please detail underneath in relevant section and provide priority rating and determine if full EIA is required.

Gender

Positive Impact Negative Impact Reasons

Men no no

Women no no

Race

Asian or Asian British People

no no

Black or Black British People

no no

Chinese people

no no

People of Mixed Race

no no

White people (including Irish people)

no no

People with Physical Disabilities, Learning Disabilities or Mental Health Issues

no no

Document Title: Mental Health and Learning Disabilities Inpatient Supportive Observation Policy

Purpose of document To set out safe standards for the observation of patients within Mental Health Units.

Target Audience All staff working with Isle of Wight Trust Mental Health Business Unit

Person or Committee undertaken the Equality Impact Assessment

Clinical Quality and Safety Lead for Acute and Inpatient Mental Health Services.


Sexual Orientation

Transgender no no

Lesbian, Gay men and bisexual

no no

Age

Children

no no

Older People (60+)

no no

Younger People (17 to 25 yrs)

no no

Faith Group no no

Pregnancy & Maternity no no

Equal Opportunities and/or improved relations

no no

Notes: Faith groups cover a wide range of groupings, the most common of which are Buddhist, Christian, Hindus, Jews, Muslims and Sikhs. Consider faith categories individually and collectively when considering positive and negative impacts. The categories used in the race section refer to those used in the 2001 Census. Consideration should be given to the specific communities within the broad categories such as Bangladeshi people and the needs of other communities that do not appear as separate categories in the Census, for example, Polish. 3. Level of Impact If you have indicated that there is a negative impact, is that impact:

YES NO

Legal (it is not discriminatory under anti-discriminatory law)

Intended

If the negative impact is possibly discriminatory and not intended and/or of high impact then please complete a thorough assessment after completing the rest of this form. 3.1 Could you minimise or remove any negative impact that is of low significance? Explain how below:

3.2 Could you improve the strategy, function or policy positive impact? Explain how below:

3.3 If there is no evidence that this strategy, function or policy promotes equality of opportunity or improves relations – could it be adapted so it does? How? If not why not?

Scheduled for Full Impact Assessment Date:

Name of persons/group completing the full assessment.

Date Initial Screening completed