Improving therapeutic engagement and observations on inpatient mental health wards in the English National Health Service: lessons from using quality improvement to scale up interventions

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. Results seen:

• general observation completion increased by 1.2%
• 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%