Constant special observation and self-harm on acute psychiatric wards: a longitudinal analysis

ObjectiveSpecial 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.MethodA longitudinal analysis of officially collected data covering a period of 2 1/2 years from 16 acute wards at three Hospitals in London.ResultsThere 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.ConclusionThe lack of association with self-harm suggests that the use of constant special observation could be reduced without compromising patient safety.