What to look for during constant observations: Expert consensus and a tool for observations recording

Abstract

Introduction. Supportive observations are common in mental health care but there are no guidelines on best practice or what should be documented in observations records. Aim. To develop expert consensus on the important aspects of patient presentation that inform clinical decision-making about observations, and to develop a recording tool from this consensus. Method. A Delphi methodology was used to consult an expert panel of mental health clinicians and academics to agree on what aspects of patient presentation during constant observations are important in informing clinical decisions. Thematic analysis was applied to the agreed item set to extract common aspects of presentation and behaviour. Results. The panel considered 118 individual items across three rounds of consultation and agreed that 51 items were important to clinical decisions about observations. Thematic analysis found six man themes: agitation, self-harm and suicide, violence, negative influence, disengagement and positive behaviour. Sub-themes were used to create the MerseyCare Supportive Observations Recording Tool (MSORT). Discussion. These data represent the first expert consensus on the aspects of patient presentation that are important to clinical decisions. Implications for practice. Consensus items should be recorded in observations records and be considered in decision-making about observations. The MSORT may aid observations recording.