Strand 8. Supporting personalised care and treatment

It is saying ‘How are you?’ not just ‘Oh she is agitated!’ ‘How are you feeling? What is making you feel this way? What can we do to help?’ That would help me." Service user

It’s important to remember that observation and risk status do not always accurately reflect the underlying care and treatment needs of all patients and, in isolation, do not accurately indicate the true extent of therapeutic activity required to deliver personalised and proactive care and treatment interventions to prevent or respond to deterioration. A focus on clinical needs and purpose of admission, as well as deterioration or risk factors is required and ward staff should ensure that each patient has a care, treatment and safety plan in place that:

  • is collaborative, anticipatory and designed around the needs of the individual patient
  • is recovery focused and involves the patient in their development and review, in line with the Rights in Mind pathway
  • is focused on addressing identified risks and triggers for deterioration or harm
  • addresses the issues (if known) causing or worsening symptoms or the risks, triggers or issues behind the patient’s admission to hospital, ensuring that the patient has access to activity, therapeutic intervention and recreation, and is supported to maintain family relationships in line with the Rights in Mind pathway
  • will flexibly scale up or down the nature or frequency of relevant, interpersonal, evidence or values-based interventions to meet the health care needs of the patient during the day or night – for example, by increasing the frequency of personalised intervention or contact to build a relationship and sense of continuity when the patient is early on in the admission process and/or at risk of deterioration, unscheduled absence, self-harm, self-isolation, expressing suicidal ideas, violent, or at risk of physical harm associated with confusion or the risk of falling
  • will seek to provide evidence of a patient’s consent to temporary, continuous intervention
  • will have multidisciplinary consideration, forward planning and decision making at its centre, enabling nursing staff to flexibly scale up or down the intensity of intervention

Putting guidance into practice

A close understanding of a patient’s clinical needs and strengths, as well as the risks or triggers for harm or deterioration, will help staff to develop collaborative relationships with patients and then align these needs with appropriate, specific and personal interventions.

Ward staff should

  • ensure that care and treatment interventions are aligned to the documented clinical needs and triggers for deterioration or risk for each patient and carried out with their involvement or with carer involvement where consent is given
  • seek to understand the lived experience of patients and their families and engage their participation, consent and choice about care and treatment – care, treatment and safety plans should evidence carer or family consultation and engagement
  • utilise advance statements wherever possible (in line with the Rights in Mind pathway) with care plans evidencing discussion and collaboration with patients and a rationale for not complying with an advance statement being provided, in writing, to the Mental Welfare Commission for Scotland and the patient themselves

For more information, please refer to our From Observation to Intervention (PDF) guidance document.