Monitoring and Observation of Patients in Wards

Reference is made to the DGHS Circular 01-15/2004 dated 08.07.2004 as well as internal circulars 06/ 2003 and 01/2004 of NIMH

1. High risk patients should be kept in beds closest to Nursing Station to keep them within the purview of the on duty Nursing Officers 2. Any change in a patient that deems risky by the Nursing Officers should be informed to the on call Medical

Officer in person or over the phone. 3. Handling of severely disturbed patients or highly suicidal patients need close supervision by Medical Officers. 4. Any complications or drug side effects noted in patients should be updated to Medical Officers by the Nursing

Officers. 5. All morning admissions should be shown to the On Call Medical Officer in the afternoon. All Afternoon admissions should be shown to the night on call Medical Officer. All night admissions should be shown to the morning on call Medical Officer by the Nursing Officers. 6. All fall risk patients need to be kept under close observation. 7. Significant clinical events should be updated to the on duty Special Grade Nursing Officer by the Nurses in addition to informing the On Call Medical Officer. 8. Night rounds in acute wards are best done after 8.00 pm to get a clear picture of the ward patients. 9. Nurses must regularly update about risk patients in the ward to the Medical Officers on duty. Medical Officers are expected to review these patients as per standard protocol. 10. Medical Officers are expected to document their review notes clearly on the BHT. 11. Nurses are expected to document their observation notes in the relevant charts. 12. Medical Officers may contact the Senior Registrar or the Consultant Psychiatrist for senior opinion on any clinical matter and they may call the Director/ Deputy Director for any administrative issue whenever necessary. 13. Any issues related to the support staff allocation or movement should be reported to the Administrative

Officer. 14. All Incidents must be reported and followed up. 15. Standard protocols should be followed in routine bed making, cannula supervision and temperature and vitals monitoring done daily. 16. As much as possible patients should be provided bed sheets and pillows. 17. Special Grade Nursing Officers must do random ward rounds to check and ensure Nursing Care is provided up to the standards. 18. Level of Close Observation: (To be done by Nursing Officers with the support of Attendants and

Health Service Aids as ordered by the Medical Staff ) I. Low level observation-baseline level, frequency - once every 30 - 60 minutes.

II. High level intermittent observation -to patients who are risky but do not represent an immediate risk. Frequency - 15 to 30 minutes.

III. Continuous observation- when patient having immediate threat and needs to be kept within eyesight or at arm‘s length

IV. Multi-professional continuous observation. - When a patient is at high risk of harming themselves or others and needs to be kept within the eyesight of 2 or 3 members and arm‘s length of at least one staff member.

(Level III and IV observation can only be ordered by Consultant Psychiatrist or Senior Registrar)