12 May 2025

CNWL launched an Enhanced Therapeutic Observations Collaborative (ETOC) case study in 2024 to improve patient care and reduce unnecessary seclusion in mental health wards. The initiative would enhance observation practices and improve patient experience.

The changes were to:

  • Standardise recordings of observations using the Brigid app, replacing manual records.
  • Make data-driven improvements using Tableau to track observation trends and financial expenditure.
  • Implement ward engagement strategies, such as ‘Getting to Know Me’ cards, zonal observations, and confidence-building initiatives for nursing staff.
  • Provide education and training for staff, including reflective groups and post-incident debriefs.

The following improvements were achieved:

  • Positive impact on ward stability: Zonal observation helped create a more settled environment.
  • Financial improvements: Observation-related expenditure reduced, though overall staffing costs remained constant.
  • Staff also noted that the app reduces errors in transcription.

Some of the challenges encountered were:

  • De-escalation: Nurses hesitated to step down observations without medical approval, requiring more training.
  • Diverse patient cohorts across boroughs made a standardized approach difficult.

The programme is set to run until September 2026. The plans are to:

  • Expand activity coordinator roles to a 7-day service.
  • Develop a digital dashboard for tracking ward and patient-level data.
  • Utilise the Acute Care Forum to foster shared learning among teams.
  • Conduct a final evaluation to assess the sustainability of the changes made.

Read more about it here.