Enhanced observation and care collaborative


We're supporting NHS providers to improve enhanced observation and care.

We're supporting trusts taking part in the collaborative to adopt improvement methodologies and creating a learning community for them to discuss the changes they're implementing. 

We will be sharing trust's findings as they progress through their quality improvement journey, so you can learn and implement them in your own trust.

What is enhanced observation and care?

There has always been a need for one-to-one nursing care, also known as special observation or specialling, for critically ill or vulnerable patients in hospital. Definitions of enhanced care come largely from mental health nursing, with different levels of observation defined by the proximity of staff to the patient needing enhanced care. Studies on enhanced care in acute settings have built on this, with a driver to move from ‘passive watching’ to an engaged person-centred relationship with the patient and their family or carers.

Special observation is delivered following an individual assessment undertaken by nurses with advanced assessment and care planning skills using a nurse-patient ratio of one-to-one to enable person-centred therapeutic practice interventions and promote safety. Best practice special observation is promoted through the delivery of evidence based education and monitoring of adherence to a single policy.

A definition from a study by Kerr, Verner and Traynor (2013).

Aims of our collaborative

  • to improve the quality, safety and patient experience of one-to-one care
  • to deliver an improved experience for the most vulnerable hospital in-patients
  • to ensure trusts have the tools and information to undertake an improvement project
  • to measure, monitor and reduce the cost of one-to-one care

Supporting the rationale for change

  • patients feel safer and more supported when the observer is known to them and actively engaged with them
  • patient engagement and staff autonomy show encouraging results in reducing conflict and reduction in intensive observation
  • therapeutic interventions benefit patients

Challenges in practice

  • culture shift to change the way patients are cared for
  • the need to have a clear policy and effective staff training
  • can be a difficult experience for service users and staff
  • involvement of family

Join the conversation on Twitter using #ImproveEnhancedCare.

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