1. Review of Observation Policy What triggered the review? 4 in-patients deaths where observation was a factor. Methodology Reviewed SUI reports and disciplinary cases over a 12 month period to identify where observation had been a factor. Multi-disciplinary focus groups - large cross section of staff. Literature review Commissioned NCISH to undertake a review of the four deaths. Findings from that review were provided at a professional seminar on the 17 Oct 2013. Considered findings from Coroner hearings

2. Outcomes Established a set of principles based on positive risk and therapeutic engagement Clinical risk assessment is the basis for determining levels of observation and not ‘custom and practice’ Change in emphasis - revised policy is now called the ‘Engagement and Observation’ policy. Removed 60 and 30 minute timed observations Intermittent observation at other intervals (e.g 15 mins) must be clearly risk assessed, purposeful and undertaken with the utmost diligence to ensure patient safety is maintained at all times. Reduction in observation can be authorised by senior non-medical clinicians

3. Additional points NICE Guideline 25 review is underway and we await the outcomes from this The NCISH review broadly supports our proposals in respect of the revised policy. We are carrying out a phased implementation of the revised policy which is being monitored by the Trust’s Safety Programme Board Thank you anthony.deery@ntw.nhs.uk