Mersey Care NHS Foundation Trust Policy states that as a minimum, all psychiatry inpatients should have their physical observations ‘undertaken and documented weekly’. Consensus amongst staff at Rathbone Rehabilitation Centre, a 26-bed psychiatric rehabilitation facility, was that compliance was sub-optimal. Staff were concerned that failing to monitor the vital signs of our patients would reduce the early detection of illness in our particularly vulnerable patient group.

In the 6-week pre-intervention period, the percentage of patients having their observations measured each week ranged from 29% to 71%, with a median of 52%. Conversations across the MDT exposed three significant barriers to compliance:

1. Staff knowledge and education

2. Workforce weekly schedules

3. Method of recording observations

I implemented a series of interventions to overcome the above barriers:

1. I held conversations with all staff involved with undertaking observations to ensure that they were aware of both the guidelines, and the positive impact that adherence has upon patient care.

2. I therefore worked alongside the Ward Manager to ensure that protected time for staff to complete observations was introduced to the weekly timetable.

3. I introduced simple tick–box sheet at the front of the observation folder so that at a glance, staff could see which observations were still outstanding.

After implementation, we experienced a significant improvement over the following 6 weeks. The percentage of patients having their observations undertaken in any given week ranged from 72% to 100%, with a new median of 90%. Run chart analysis demonstrated a shift, as all 6 post-intervention data points were situated above the initial median of 52%, thereby demonstrating a statistically significant improvement.

This project demonstrated how a series of simple interventions led to a statistically significant increase in our adherence to Trust Policy, and a subsequent improvement in patient care.