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Gen Hosp Psychiatry. 2009 Nov-Dec;31(6):523-30. doi: 10.1016/j.genhosppsych.2009.05.008. Epub 2009 Jun 23.

Constant special observation and self-harm on acute psychiatric wards: a longitudinal analysis.

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  • 1School of Community and Health Sciences, City University, E1 2EA London, UK.



Special observation (the allocation of nurses to watch over nominated patients) is a method of preventing patients harming themselves. This study assessed the relationship between constant special observation (keeping a patient within eyesight or reach) and rates of self-harm on acute psychiatric wards.


A longitudinal analysis of officially collected data covering a period of 2 1/2 years from 16 acute wards at three Hospitals in London.


There was no statistically significant association between constant special observation and self-harm outcomes. Use of observation varied markedly between hospitals and wards, but overall, there was a significant decline over time. Self-harm incidents were rare (recorded in only 7% of ward weeks) and did not decline over time, but were correlated over consecutive weeks.


The lack of association with self-harm suggests that the use of constant special observation could be reduced without compromising patient safety.

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