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 Trust-wide ETOC Lead to coordinate and develop this work across LUHFT (Ged Jennings, Ged.jennings@liverpoolft.nhs.uk)
  • Currently developing a new Trust-wide ETOC policy focused on professional judgement, therapeutic engagement, least restrictive practice and shared team responsibility
  • Introducing a revised three-level ETOC framework to support  consistency and safer decision-making
  • Running large-scale staff engagement and co-production sessions with HCAs, nurses, matrons, patients and family/ carers to shape the future ETOC model
  • Developing new staff and patient/carer information packs with staff, volunteers, patients, families and carers
  • Improving behaviour charting processes and aligning work with MELO, Transfer of Care Hubs and discharge planning pathways
  • Developing new ETOC education and workforce programmes including Patient Ready AI simulation, therapeutic engagement training, de-escalation and behaviour support, dementia, delirium, LD and autism awareness and IKON personal safety training
  • Exploring innovative approaches including immersive simulation, experiential learning and digital patient safety technologies
  • Building a Trust-wide approach that supports both patient safety and staff wellbeing.