Aurelio Marco, Singh Sasha, Chitewe Auzewell, Mckenna Claire, Marufu Evah, Bridle David, Sunduza Lorraine, Shah Amar
East London NHS Foundation Trust, Robert Dolan House, 9 Alie Street, London, E1 8DE, United Kingdom.
National Institute for Health and Care Excellence, 2 Redman Place, London, E20 1JQ, United Kingdom.
Int J Qual Health Care. 2025 Jul 4;37(3). doi: 10.1093/intqhc/mzaf070.
Observations on mental health inpatient wards account for a large amount of staff time and cost to organisations. Ideally, observations should support meaningful engagement between staff and service users on wards, benefiting both the recovery of service users and the well-being of staff. However, observation practice is varied, and the therapeutic benefit it brings is questioned in some instances.
Over 18 months, 55 inpatient mental health wards across one English National Health Service (NHS) Foundation Trust employed Quality Improvement (QI) methodology to test interventions aimed at improving observation completion and therapeutic engagement. A standard framework for scaling up was used to sequence the work and support moving from testing a large number of interventions locally to scaling three across the organisation. The three interventions were a board relay, zonal observations, and the use of life skills recovery workers to lead activities. Measures used included general and intermittent observation completion, incidents of violence and agression (physical, verbal and racial), restrictive practice (prone restraint, restraint, seclusion, and rapid tranquillisation), and staff sickness.
Sustained improvements were seen in all 10 measures used in this work, as evidenced by shifts in statistical process control charts. General observation completion increased by 1.2%, and intermittent observation completion rose by 1.9%. Incidents of physical violence were reduced by 23%, verbal aggression by 38% and racial aggression by 60. Restrictive practice use also reduced, with restraint reduced by 16%, prone restraint by 35%, seclusion by 38%, and rapid tranquillisation by 26%. Staff sickness also decreased by 16%.
Observation completion and therapeutic engagement have been shown to improve with zonal observations, a board relay, and life skills activities led by recovery workers. QI can be used to test and scale interventions rapidly across a system.
精神科住院病房的观察工作占用了工作人员大量时间，也给机构带来了成本。理想情况下，观察应有助于工作人员与病房中的服务使用者进行有意义的互动，这对服务使用者的康复和工作人员的福祉都有益。然而，观察实践各不相同，在某些情况下其带来的治疗效果受到质疑。
在18个月的时间里，英国一家国民健康服务（NHS）基金会信托旗下的55个精神科住院病房采用质量改进（QI）方法，测试旨在提高观察完成率和治疗性互动的干预措施。一个扩大规模的标准框架被用于安排工作顺序，并支持从在当地测试大量干预措施转向在整个机构推广三项措施。这三项干预措施分别是看板接力、分区观察以及使用生活技能康复工作人员来主导活动。所采用的指标包括常规和间歇性观察完成情况、暴力和攻击事件（身体暴力、言语暴力和种族暴力）、限制措施（俯卧约束、约束、隔离和快速镇静）以及工作人员病假情况。
这项工作中所使用的全部10项指标都出现了持续改善，统计过程控制图的变化证明了这一点。常规观察完成率提高了1.2%，间歇性观察完成率提高了1.9%。身体暴力事件减少了23%，言语攻击减少了38%，种族攻击减少了60%。限制措施的使用也有所减少，约束减少了16%，俯卧约束减少了35%，隔离减少了38%，快速镇静减少了26%。工作人员病假情况也减少了16%。
分区观察、看板接力以及由康复工作人员主导的生活技能活动已被证明能提高观察完成率和治疗性互动。质量改进可用于在一个系统中快速测试和推广干预措施。
