Who's got the obs sheets? Can QI methods reduce violence and restrictive practices on inpatient mental health wards?

You are in the ward office, you hear the same question multiple times every day… “who’s got the observation sheets?”

Everyone’s busy, the office is full, but who’s “out on the ward” and available to the service users? You want to do more to provide therapeutic care, but you’re not sure if the observation process is therapeutic? It’s busy and you can’t find time to do more. Sound familiar?

Observations are a means to keep someone safe, often implemented by a head around the door and a brief ‘hello’, but arguably more like surveillance than therapeutic engagement and increasingly involving unproven or harmful technologies. This approach has been criticised for feeling impersonal and failing to build meaningful relationships (Cusack et al., 2018).

Observation practices are often linked with restrictive practices, which can cause psychological harm, damage staff and patient relationships, and even be retraumatising (Kontio et al., 2012; Cusack et al., 2018), with physical and psychological risks to both service users and staff (Soininen, et al. 2013). Alternatives to observations emphasise empathetic interaction, meaningful activities, and therapeutic community approaches (Kontio et al., 2012).

A recent QI programme across a large UK mental health Trust, tested three interventions that aimed to augment the observation process and improve therapeutic care on 55 different wards. These included wards for adults, adolescents, and older persons covering acute, intensive care, forensics and rehabilitation services.