Strand 6. Managing periods of continuous intervention and support
When I was cared for after injuring myself – the nurse was gentle and respectful." Service user
There will be times when a patient requires brief periods of continuous intervention. This may be because early intervention activity has proved unsuccessful or to provide reassurance when the patient is feeling unsafe, at immediate risk of harm, or unable to engage in a planned activity within their care, treatment and safety plan.
Continuous intervention may also be employed to reduce distress or vulnerability or to promote dignity in the case of disinhibition. However, it should always be used as a last resort, as a way to explore more focused programmes of personalised intervention, as part of a continuum-based approach, and in the context of the patient’s care, treatment and safety plan. Any proposed continuous intervention – including continuous visual assessment – must be backed by evidence that it is purposeful and goal-directed, and that alternative interventions have already been tried.
Proactive reviewing seeks to understand any benefit that continuous intervention is providing – from both patient and staff perspectives – and provide considered alternatives such as more frequent interaction, interventions which monitor wellbeing or planned self help, and social or group activities, based on what the patient and their family or carer advise is usually helpful to them. Our test site findings indicate that psychotherapeutic and other personalised, activity-based interventions lead to a reduction in the length of time that patients need continuous intervention.
Putting guidance into practice
After an initial 8-12 hours of continuous intervention, a review must take place to assess its effectiveness. If the continuous intervention is still in place and deemed to be appropriate up to or after 24 hours, its purpose, the nature of the intervention and alternative plans to scale it back should be reviewed every 8-12 hours (minimum) by the clinical team involved in the patient’s care, the multidisciplinary staff who have spent time with the patient, and the patient themselves.
Ward staff should
- ensure that all specific, personalised activity is delivered by core, familiar staff who are skilled in a range of psychotherapeutic interventions
- ensure that any continuous intervention is experienced by the patient as a continuum of their care, treatment and safety plan and is responsive to their individual needs at the time and not solely dependent on risk while staying focused on the safety of the patient and other individuals
- understand that areas of risk can be addressed through psychotherapeutic intervention on a frequent or structured basis, without necessarily requiring continuous intervention
- focus on being ‘with or alongside’ the patient to provide support, structured intervention, ongoing assessment and reassurance – not watching the patient from a distance
- promote activities that enhance the patient’s ability to engage with others and develop coping skills and self-esteem during all personalised interventions
- ensure that patients do not face any undue restrictions, such as withdrawal of rights to see their family or engagement in day-to-day activities, unless there are evidenced and documented significant risks in doing so
- avoid informal seclusion or physical containment of a patient in their room with staff seated outside and minimum interaction – this is unacceptable unless the patient is at risk of violence or has requested isolation in which case the rationale and value of continuous intervention should be reassessed
For more information, please refer to our From Observation to Intervention (PDF) guidance document.