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Oxford Healthcare Improvement

Supporting Oxford Health to provide safe, better quality care to its patients and improve the working lives of its staff.

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Reducing time spent on enhanced observations for service users

Service users admitted for care in acute or psychiatric intensive care units may be so unwell that they present a risk to themselves or others.  There is little empirical evidence to support the practice of enhanced observations although the practice is widespread in the UK (De Santis et al., 2015; Muralidharan & Fenton, 2006). Enhanced observations are commonly used to reduce the risk of self-harm, suicide and to prevent violence and aggression (Bowers et al., 2000). In some situations, enhanced observations may not enhance safety or have a negative influence on the service user’s mental state. (2008; Chu, 2016; Stewart, Bowers & Ross, 2012). In the local service, staff wish to work on reducing the time service users spend on enhanced observations through the introduction of a coached quality improvement project designed to test a number of changes in practice to benefit both patients and staff.

Project aim

To reduce the amount of time spent on enhanced observations in Ashurst Ward, a psychiatric intensive care unit (PICU), by 15% by 1 January 2019.


The project employed the Institute for Health Improvement (IHI) Improvement model.  The team began by taking a set of baseline measures to better understand the amount of time spent on regular and enhanced observations, as well as reasons for enhanced observations and the roles of staff who carried out enhanced observations. Patients were offered the opportunity to talk with an independent worker from the Patient Experience Team to collect their views on the current observation practices in the PICU.  Next, a driver diagram was developed to identify major issues contributing to the use of enhanced observations, based on analysis of the data, a literature review, and facilitated discussions to capture staff theories and ideas.


The team has identified their first test of change to improve the handover of information between staff who are undertaking enhanced observations and patients subject to enhanced observations.

  • Establishing the purpose of the observations being carried out for both staff and the service user.
  • Understanding the service user’s experience and preferences for making the most of time on enhanced observations.
  • Describing key lessons/points from the previous observation to ensure continuity.

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This is a prescribed app. It should only be used alongside a face to face intervention provided by a mental health worker. Check with your local service to see if they subscribe to the app.