A wide range of patients and circumstances are present within an acute hospital environment. People may deteriorate clinically, physically, or psychologically which may affect their capacity 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).

This can also be due to underlying conditions e.g. dementia, mental health deterioration or diagnosed psychiatric disorder, or any other cognitive impairment, e.g. acquired brain injury and drug and alcohol use.

Supportive observations will be seen as an integral part of a therapeutic plan. The purpose of supportive observation is to ensure the sensitive monitoring of the person’s 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 amended by Mental Health Act 2007, Code of Practice published 2015, NICE Clinical Guidelines NG10, The Mental Capacity Act (MCA) 2005 and the Standard Nursing Midwifery Councils Practice Guidance. Care should be taken to ensure that supportive observations do not unlawfully 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 who may be at risk of harm to either themselves or others. This is delivered as part of a broader risk management, and care planning approach.


Policy Details

Download: PDF version
Compiled by: Jane Mitchell - Professional Head of Safeguarding
Sarah Hill - Named Nurse for Adult Safeguarding
Kamla Bhoyraz - Clinical Nurse Dementia Lead
Ratified by: Safeguarding Committee
Date Ratified: December 2023
Date Issued: December 2023
Review Date: December 2026
Target Audience: All nursing and midwifery staff
Contact name: Jane Mitchell / Sarah Hill / Ellen Bull / Kamla Bhoyraz


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