Systematic Review of Interventions to Improve Constant Observation on Adult Inpatient Psychiatric Wards

Constant observation is frequently conducted on inpatient psychiatric units to manage patients at risk of harming themselves or others. Despite its widespread use, there is little evidence of the efficacy of the practice or of its impact on patients and nursing staff. Unnecessary use of this practice can be restrictive and distressing for all involved and can cause considerable strain on healthcare resources. We sought to review interventions aiming to improve the quality and safety of constant observation or to reduce unnecessary use of this restrictive practice on adult inpatient psychiatric wards. A systematic search conducted in December 2018 using PubMed, PsycINFO, CINAHL, EMBASE and Google Scholar identified 24 studies with interventions related to constant observation. Only 16 studies evaluated a total of 13 interventions. The most common intervention components were changes to team, education and training for staff, changes to record keeping and assessment, and involving patients in care. A range of outcome measures were used to evaluate interventions. Over half of the interventions showed some positive impact on constant observation. One study recorded patient feedback. All interventions were targeted towards mental health nurses. Overall, there is no consensus on how best to improve the safety and quality of constant observations or reduce its unnecessary use. Studies vary widely in design, intervention and outcome measures. Existing research does however suggest that teamwork interventions can improve the patient experience of constant observation and safely reduce their degree and frequency. Priorities for future research on constant observations are highlighted.