A wide range of patients and circumstances are present within an acute hospital environment. People may deteriorate clinically, physically or psychologically which affects their state of self-control and ability to maintain personal safety.

This can be due to drug administration (e.g. sedation / potent analgesia) or acute changes to their clinical state (e.g. electrolyte imbalance or hypotension).

This can also be due to underlying conditions (e.g. Dementia) or unstable behaviour patterns, mental health deterioration or diagnosed psychiatric disorder.

Supportive observation will be seen as an integral part of a therapeutic plan. The purpose of supportive observation is to ensure the sensitive monitoring of the persons physical state, behaviour and mental state, enabling a rapid response to any change, whilst at the same time fostering positive therapeutic relationships. This may be achieved by establishing good rapport with the person using services, promoting their coping skills and being aware of their individual needs.

Good practice in supportive observation is essential: This policy follows the principles embodied in the Mental Health Act 1983 Code of Practice published 2015, NICE Clinical Guidelines NG 10, The Mental Capacity Act (MCA) 2005, National Collaborative on Enhanced Care (NHSi 2019), Safer Nursing Care Tool (Shelford Group, 2018) and the Standard Nursing Midwifery Councils Practice Guidance. Care should be taken to ensure that supportive observations do not contravene a patient’s rights.



The purpose of this policy is to ensure the appropriate resources and skillset of staff is available to observe and care for deteriorating patients, minimise the risk of harm to potentially suicidal, violent or vulnerable patients. This is delivered as part of a broader risk management, clinical intervention and care plan.


Policy Details

Download: PDF version
Compiled by: Matthew Barker, Deputy Chief Nurse - Workforce
Ratified by: Andrea Lewis, Interim Chief Nurse and NMAHPPB
Date Ratified: December 2020
Date Issued: January 2021
Review Date: December 2022
Target Audience: All nursing and midwifery staff
Contact name: Matthew Barker, Deputy Chief Nurse - Workforce


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