Patients at risk of self-harm: continuous observation — HSSIB Investigation

Summary

2 recommendations 14 learning prompts 2 of 2 responded

Safety Recommendations

2 total

R/2024/025 Department of Health and Social Care

HSSIB recommends that the Department of Health and Social Care, through the National Institute for Health and Care Research (NIHR), assesses the priority, feasibility and impact of future research into the efficacy and acceptability of continuous observation of mentally unwell adult patients. The research should take into account different care settings in which continuous observation may take place (including physical and mental health hospitals) and the different staff groups involved in carrying it out.

The NIHR will consider the recommendation through its research commissioning processes, assessing existing evidence and engaging stakeholders to determine the most appropriate mechanism for future research, which may include a new call or integration into current work.

Response received 22 July 2024

The National Institute for Health and Care Research (NIHR) funds health and social care research that improves people’s health and wellbeing. Working with those who use, plan and deliver health services in the UK, we identify and prioritise important topics to fund through specific calls for research. Following referral from HSSIB, the safety recommendation for ‘Patients at risk of self-harm: continuous observation’ will be considered through the NIHR’s established research commissioning processes with the aim of generating high-quality evidence to support decision making. After an initial ‘in-house’ assessment of the topic to determine what is already known (the existing evidence base), we will engage with a wide range of individuals with a broad spectrum of knowledge, skills and expertise to agree the most appropriate mechanism to address the outstanding uncertainties. This may result in the development of a new NIHR commissioned call for research or exploring whether the research question can be accommodated into an existing NIHR commission. Response received on 22 July 2024. --------------------------------------------- May 2026: HSSIB has been notified by the National Institute for Health and Care Research that all actions have been completed.

R/2024/026 NHS England

HSSIB recommends that NHS England, working with relevant stakeholders, produces national guidance for staff undertaking continuous observation of mentally unwell adult patients, along with a training and competency framework to provide staff with the necessary skills for this intervention in different care settings (including physical and mental health hospitals). Development of this guidance should include engagement with human factors principles to understand the complexities of the task of continuous observation and the environments in which it may take place.

NHS England is developing national principles for therapeutic engagement, including competencies, applicable across all care settings. This work, informed by human factors, will be overseen by a task and finish group with expected completion by June 2025.

Response received 10 October 2024

We welcomed the investigation and recommendations within the review. Two Chief Nurses from our Mental Health and Learning Disability services have been progressing work to develop national principles that set out good practice in relation to therapeutic engagement as we prefer to call it, which will be applicable across both physical and mental health provider organisations. This will include competencies currently in place in provider organisations. The Chief Nurse at East London Foundation Trust, and the Deputy Director Mental Health Nursing will co-chair a task and finish group supported by the Deputy Director for Safety and Improvement-Nursing, to oversee the work, which will be informed by safety science and human factors. The output from this will apply to all care settings. We expect to complete this by June 2025. This work will align with the work underway in relation to physical health setting and the Enhanced Therapeutic Observations Collaborative (ETOC), which is being led by the NHS England Nursing Workforce Team. We agreed it is important to have early engagement with us in relation to your investigations and in the development of recommendations to enable us to provide relevant advice which may contribute to, inform your investigation approach, and avoid duplication with work being undertaken by the Mental Health and Learning Disability Quality Transformation team. Response received on 10 October 2024 and updated on 17 January 2025. ------------------------------------------------------------------------------------------- May 2026: HSSIB has been notified by NHS England that all actions have been completed.

Learning Prompts

14 total

Prompt 1 Learning prompt Is there a shared understanding of the different roles and responsibilities of mental and physical healthcare staff in caring for a patient, including checking their personal belongings for items that could be used to self-harm. Are the different roles and responsibilities documented in care plans and shared at shift handover?

Prompt 2 Learning prompt Is there a shared approach to supervision and support for all staff involved in caring for patients who may self-harm in hospital?

Prompt 3 Learning prompt Is there a clear and comprehensive process for handing over a patient’s care to staff on the receiving ward?

Prompt 4 Learning prompt Is there a shared approach to, and understanding of, how to respond if the patient were to self-harm?

Prompt 5 Learning prompt Is there a physical healthcare hospital policy for the care of patients with mental health needs which includes continuous observation?

Prompt 6 Learning prompt Is there a mechanism for regular communication and review of a patient’s risk of self-harm and need for observation?

Prompt 7 Learning prompt Is there comprehensive, clear, and accessible documentation available to both mental and physical healthcare staff?

Prompt 8 Learning prompt Is there a process to ensure staff undertaking continuous observation who are new to an acute hospital ward are introduced to staff and the environment, including rest facilities and access to relevant patient records?

Prompt 9 Learning prompt Is there a mechanism to allow for shared learning and reflection between care providers involved in caring for patients at risk of self-harm?

Prompt 10 Learning prompt Is there a process to promote respectful and kind interactions and communication between the staff at different healthcare providers?

Prompt 11 Learning prompt Are there arrangements in place to provide appropriate support for all staff providing this intervention?

Prompt 12 Learning prompt Are staff being regularly rotated so that they are not undertaking continuous observation for more than 2 hours in line with national guidance?

Prompt 13 Learning prompt Are staff having adequate breaks, with ready access to water and food?

Prompt 14 Learning prompt Are staff supported to speak with or engage in an activity with the patient where appropriate?