Therapeutic Observations of Patients - Kent and Medway NHS and ...

Kent and Medway
NHS and Social Care Partnership Trust
Therapeutic
Observations
of Patients
This Aide Memoire must be
read in conjunction with the
Trust’s Therapeutic
Observations of Patients Policy
Better Together

PATIENT OBSERVATIONS
Patient Observations are carried out
when there is an immediate or potential
danger of a patient harming themselves
or others. This usually includes patients
who have a history of self-harm,
violence, vulnerability or being
exploited. The aim is to minimise the
risk of harm occurring.

Although the term “Nurse” is used, other
professionals may carry out observations.
Observation must not be simply a
custodial activity but should provide the
nurse with an opportunity to interact
with the patient in a therapeutic way on
a one-to-one basis.
Where possible and appropriate the nurse
should be the same gender as the patient
in order to protect privacy and dignity.

THERE ARE FOUR TYPES OF
OBSERVATION
General
The location of all patients should be
known to staff, but not all patients need
to be kept within eyesight.
Intermittent
The patients location is checked every
ten to thirty minutes (exact time to be
specified in the care plan).

Within eyesight
The patient should be within eyesight at
all times.
Within arms length
The patient should be within arms
length at all times.

PROCEDURE
All patients are observed and reported on
daily. At all levels of observation, the nurse
should be able to report on the patient’s:
• General behaviour
• Movements
• Posture
• Speech
• Expression of ideas
• Appearance
• Eating / dietary intake
• Mood, attitude and orientation
• Response to medication
• Physical condition

A record must be made in the patients
notes after each period of observation
and the observation recording form
must be completed for all patients
except those on general observations.

WITHIN ARMS LENGTH
• The observing nurse must maintain
arms length contact at all times,
observing the patients movements,
actions, behaviour, mood etc. This will
enable the nurse to notice any
warning signs, possible suicide
attempts, aggressive outbursts etc.
The patient must be escorted
everywhere, including to the toilet and
bathroom by the observing nurse.

• The observing nurse should try to
occupy the patient with suitable
activities if appropriate. However, it is
important to bear in mind that the
patient may be too ill to participate or
may wish to remain silent. Upholding
the patients privacy and dignity must
be balanced against the safety of the
patient, the nurse and others.
• The observing nurse must give a verbal
report to the relieving nurse and report
any unusual occurrences/observations
to the nurse in charge.

WITHIN EYESIGHT
• The observing nurse must maintain
visual contact at all times, observing the
patients movements, actions, behaviour,
mood etc. This enables the nurse to
notice any warning signs, possible
suicide attempts, aggressive outbursts
etc. The patient can use the toilet,
bathroom etc alone but the observing
nurse must maintain visual contact.

• The observing nurse must try to
occupy the patient with suitable
activities if appropriate but it is
important to bear in mind that the
patient may be too ill to participate or
may wish to remain silent. Upholding
the patients privacy and dignity must
be balanced against the safety of the
patient, the nurse and others.

• The patient must be accompanied to
the therapy programme if attending.
Patients should be encouraged to take
part in the therapy programme but
the observing nurse must maintain
visual contact.
• The observing nurse must record and
give a verbal report to the relieving
staff member and report any unusual
occurrences/observations to the nurse
in charge.

INTERMITTENT OBSERVATION
• The observing nurse must observe the
patients whereabouts at agreed intervals
from 10 to 30 minutes as per care plan,
discreetly observing the patients
movements, actions, behaviour, mood
etc. This will enable the nurse to notice
any signs of deterioration.
• Patients on intermittent observation
must not be granted leave from the
unit without the permission of the
MDT. It may be agreed within the MDT
and the patients relatives, carers or
friends that they will take responsibility

for the patients safety if all agree that
the patient will benefit from a period
of leave away from the unit. This must
be documented in the patients notes.
• Patients on intermittent observations
should be encouraged to take part in
the therapy programme. When a
patient engages in therapy the
therapist must be made aware of the
patient’s level of observations and the
reasons they were applied.

GENERAL OBSERVATION
• During a span of duty, the nurse
responsible for the patients care must
be able to report at the end of the
shift, on the patients movements,
actions, behaviour, mood etc. This will
enable the nurse to have a general
awareness of the patient’s
whereabouts, any signs of
deterioration, unusual occurrences or
incidents in which the patient is
involved and what they have done
during the shift.

• The nurse responsible for the patients
care during the shift must make sure
that their colleagues are made aware
of any changes immediately.
• An entry must be recorded in patients
notes at the end of each shift.
If you require this leaflet in another
format or language please speak to your
manager or call communications on
01732 520441