Quality standard
Quality statement 4: Observation
Quality statement 4: Observation
Quality statement
People who have self‑harmed receive the observation they need while in the healthcare setting.
Rationale
Observation of people who have self‑harmed when they are in a healthcare setting can reduce distress, ensure that the person feels supported and maintain physical safety.
Quality measures
The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured, and can be adapted and used flexibly.
Structure
Evidence of local arrangements to ensure that people who have self‑harmed receive the observation they need while in the healthcare setting.
Data source: No routinely collected national data for this measure has been identified. Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from patient records.
Process
Proportion of people who have self‑harmed who have a record of observation arrangements while in the healthcare setting.
Numerator – the number of people in the denominator with a record of observation arrangements while in the healthcare setting.
Denominator – the number of people with a new episode of self‑harm.
Data source: No routinely collected national data for this measure has been identified. Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from patient records.
Outcome
Number of episodes of self‑harm occurring in healthcare settings.
Data source: No routinely collected national data for this measure has been identified. Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from patient records. The NHS National Reporting and Learning System contains national and local figures on patient safety incidents including self-harm.
What the quality statement means for different audiences
Service providers ensure that staff carry out observation in the healthcare setting according to the needs of people who have self‑harmed.
Healthcare professionals ensure that people who have self‑harmed receive the observation they need while in the healthcare setting.
Commissioners ensure that they commission services that observe people who have self‑harmed according to their needs while in the healthcare setting.
People who have self‑harmed are checked regularly by healthcare staff, and are accompanied when required, when they are in hospital or another part of the health service, to make sure they are safe.
Source guidance
Self-harm: assessment, management and preventing recurrence. NICE guideline NG225 (2022), recommendations 1.7.12, 1.7.16, 1.7.23 and 1.8.12
Definitions of terms used in this quality statement
People who have self‑harmed
People who have carried out intentional self‑poisoning or injury, irrespective of the apparent purpose of the act. [Adapted from NICE's guideline on self-harm, terms used in this guideline; self-harm]
Observation
A therapeutic intervention most commonly used in hospital settings, which allows staff to monitor and assess the mental and physical health of people who might harm themselves and/or others. It should be seen as an opportunity for active engagement as well as sensitive supervision. Observation applies to people being treated in primary care, ambulance services, emergency departments, minor injury units and inpatient settings. [Adapted from NICE's guideline on self-harm, section 1.7 and terms used in this guideline; clinical observation]