Constant special observation and self-harm on acute psychiatric wards: a longitudinal analysis.
OBJECTIVE
Special observation (the allocation of nurses to watch over nominated patients) is a method of preventing patients harming themselves. This study assessed the relationship between constant special observation (keeping a patient within eyesight or reach) and rates of self-harm on acute psychiatric wards.


METHODS
A longitudinal analysis of officially collected data covering a period of 2 1/2 years from 16 acute wards at three Hospitals in London.


RESULTS
There was no statistically significant association between constant special observation and self-harm outcomes. Use of observation varied markedly between hospitals and wards, but overall, there was a significant decline over time. Self-harm incidents were rare (recorded in only 7% of ward weeks) and did not decline over time, but were correlated over consecutive weeks.


CONCLUSIONS
The lack of association with self-harm suggests that the use of constant special observation could be reduced without compromising patient safety.
Stewart
Duncan
D
School of Community and Health Sciences, City University, E1 2EA London, UK. duncan.stewart.1@city.ac.uk
Bowers
Len
L
Warburton
Fiona
F
D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D006769:Hospitals, General / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units / Q000706:statistics & numerical data; D038801:International Classification of Diseases; D008131:London; D008137:Longitudinal Studies; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D009737:Nursing Records / Q000706:statistics & numerical data; D016017:Odds Ratio; D011567:Psychiatric Department, Hospital / Q000706:statistics & numerical data*; D011618:Psychotic Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000451:nursing; D018570:Risk Assessment / Q000706:statistics & numerical data; D012308:Risk Management / Q000706:statistics & numerical data; D016728:Self-Injurious Behavior / Q000453:epidemiology / Q000451:nursing* / Q000517:prevention & control*; D013222:State Medicine; D013405:Suicide / Q000706:statistics & numerical data; D000092864:Suicide Prevention