31 August 2023

Relaying our way towards safer observations – a standard operating procedure for Tower Hamlet’s board relay 

By Mitchell Modja (Clinical Nurse Manager, Rosebank ward), Dadai Dandato (Borough Lead Nurse, Tower Hamlets) and Sarah McAllister (Senior Improvement Advisor) 

See how Tower Hamlets Rosebank ward have used a board relay to improve therapeutic engagement and achieve zero missed observations in 7 months… 

What is the problem? 

Following a serious incident, Tower Hamlets joined the inpatient safety and quality programme.  Data from random spot checks showed that the directorate sometimes missed observations and feedback from service users and carers suggested that the experience of people on observations could be improved.  With this in mind, the directorate aimed to improve the quality (as measured on the Friends and Family test) and safety (percentage of missed observations) of therapeutic engagement and observations within a year. 

What have they been testing? 

Across the directorate, several wards have been testing change ideas, and one idea that is showing promise is the “board relay” from Rosebank ward.  This idea is based on the concept of a baton relay – you never let go of the baton until you pass it onto the next person, but in this case the baton is the observation board. 

The team have written a Standard Operating Procedure (Table 1), so the idea can be easily adopted and spread across other wards within the directorate and the Trust.

What is the data saying? 

Rosebank ward have been testing this idea since March 2023.  Through data collected by random spot checks carried out by the ward managers, the ward can see it has not had a missed observation since February 2023. 

Figure 1 – % of obs up to date at spot check per week – P chart

Recently the ward has started collecting daily observation data, and the Informatics team is supporting them to turn that data into a control chart on Power BI so they can continue to easily monitor their completed observations.  The Informatics team are also pulling data from the ward’s PREM measures so they can track whether their change ideas are impacting on the experience of service users as well.  You can view the Power BI dashboard here.

Table 1 – Board relay standard operating procedure


Figure 2 – Observation checklist


Figure 3 – Observations poster

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