As part of our approach to improving Enhanced Therapeutic Observations and Care (ETOC) across our organisation, our Corporate Nursing Team and Trust ETOC Lead reached out to colleagues who regularly undertake general observations and personalised patient care plans to ensure they were involved in how the programme is shaped going forward.

Below are a number of themes that have since been reviewed to ensure we can make ETOC clear, consistent, therapeutic and centred around patient, family and staff experience.

If you would like to share your views on ETOC, click here.

You Said

  • Observations are often seen as a HCA task, not a shared responsibility
  • Handover into 1:1 or enhanced care is inconsistent or missing
  • There is a lack of training and confidence in managing behaviours of concern or mental health
  • Patient information (likes, triggers, communication needs) is not easily available
  • There is limited debrief and recognition after challenging shifts
  • The term “ETOC” is not well understood across wards
  • Behaviour charts are hard to complete and there is no obvious system in place for doing them
  • There is limited personal safety training face-to-face
  • No one leading on this agenda Trust-wide.

We are doing

  • Appointed a dedicated Group-wide ETOC Lead to coordinate and develop this work (Ged Jennings, ged.jennings@liverpoolft.nhs.uk)

  • Developing a new Group-wide ETOC policy focused on professional judgement, therapeutic engagement, least restrictive practice, shared team responsibility and regular ETOC review

  • Introducing a revised three-level ETOC framework to support clearer decision-making, consistent language and safer review, step-down and stop processes

  • Developing a revised ETOC assessment tool and digital visibility options to help staff document rationale, review ongoing need and support safer decision-making

  • Facilitated staff, patient, family and carer engagement sessions to make sure the future ETOC model reflects real ward experience and what matters to patients

  • Developing new staff and patient/carer information packs so ETOC is easier to understand, explain and deliver in practice

  • Improving behaviour charting by supporting staff to use charts when clinically indicated, and aligning this work with Melo, Transfer of Care Hubs and discharge planning

  • Using Melo to help wards identify patterns, triggers, sleep, distress and other factors that may affect patient care, while continuing to improve usability and staff support

  • Delivering ETOC teaching through HCA/Band 2 training routes, with further education sessions planned across the year

  • Developing simulation-based training, including Patient Ready AI, therapeutic engagement, de-escalation, behaviour support, dementia, delirium, learning disability and autism awareness

  • Expanding IKON Personal Safety Training to improve staff confidence, de-escalation skills and safer responses to violence, aggression and behaviours of concern

  • Working with Security and clinical teams to review “bed watch” practice and make sure Security support does not replace therapeutic observation or clinical care

  • Building a Group-wide approach that supports patient dignity, safer care, staff wellbeing and better understanding of behaviour as communication.