Strand 4. Improving communication around clinical needs, deterioration and risk
… when I started to speak I was able to say for the first time in months about the horrible things that had been happening to me – it was a life saver." Service user
Communication within and across teams, and with patients, their families and carers, is central to anticipatory care planning and the recognition of and response to patient deterioration in mental health settings.
Getting to know patients, their families and carers well, and spending time with them, provides a valuable benchmark against which to recognise and assess subtle changes in presentation or behaviour which may indicate a potential deterioration in mental health or a potential risk of harm. Communicating concerns about a patient’s progress – or lack of progress – in a structured way can then raise early awareness and early facilitation of any specific interventions required.
Safety huddles are an extremely effective way of closing the loop of communication by putting personalised action plans in place for patients who require early intervention in the form of increased activity or other approaches which could mitigate deterioration or further deterioration. These personalised action plans should include a mechanism for reviewing progress – for example, at the next safety huddle, safety briefing or handover.
Putting guidance into practice
Multidisciplinary, patient-focused communication systems such as SBAR (Situation, Background, Assessment, Recommendation), safety briefings and safety huddles must be in place during each shift to facilitate rapid communication about patients at risk of actual or potential deterioration as well as those at risk of harm to themselves or to others.
Ward staff should
- take the opportunity to determine a patient’s wellbeing regularly, during planned contact time and whenever an opportunity presents itself – for example, during ward activity planning meetings or staff and patient community meetings
- ensure that routine checks to determine awareness of a patient’s whereabouts (in line with environmental safety and fire regulations) are interaction-based and focus on a brief assessment of wellbeing should any concerns arise
- communicate any concerns about wellbeing that are indicative of potential deterioration to the team and put a personalised action place in place, collaboratively with the patient, to support them – this should be followed up during the next safety huddle
For more information, please refer to our From Observation to Intervention (PDF) guidance document.