Enhanced Therapeutic Observations and Care

Some patients in our care may be confused, agitated or distressed as a result of their current health status, change of environment, a combination of these and personal or external factors.

During their recovery, your relative may become distressed or act differently than usual. This can sometimes lead to behaviour that feels challenging, whether this is new to you or something you’ve managed before.

For these patients, ward staff will have assessed the person as someone requiring what we define “Enhanced Therapeutic Observations and Care” (we call it ETOC for short) – this is a set of interventions to reduce the risk of harm happening.

ETOC interventions, sometimes referred to as enhanced care, aim to promote recovery and preserve safety and dignity of the individual receiving it. Through meaningful engagement, staff build trust, notice changes early, and help create moments of calm, comfort, and reassurance.

Our team will keep an eye out for any changes in the person you are supporting’s behaviour. To do this well, we need to know what’s normal for them how they usually act or respond so we can spot anything different. If you notice something that seems unusual compared to their usual behaviour, please tell the nurse or support worker caring for them.

A person may be calmer if they have a familiar person with them. We’d like to offer you the chance to spend extra time with the person you are supporting receiving ETOC interventions, even beyond the usual visiting hours (please check with the ward for standard times).

This extra time can be arranged day and/or night. The amount of time you spend is entirely up to you and can be flexible across the week. Staff will aim to discuss with you the Carer Passport and complete the Unpaid Carers Conversation Sheet. When family or friends are not present, the ward team will ensure there are dedicated staff on duty to supervise, engage, and protect the person you are supporting.

If you do stay and take the person you are supporting away from the ward, do not forget to let us know. We may ask you for a contact number so we can continue to check in and ensure the person you are supporting is safe.

Assessment and Planning for ETOC Care

On arrival to the ward, the person is assessed by the registered nurse looking after them. The assessment includes gathering information on their personal, health and social background, identifying potentially harmful behaviour, as well as information into what may help them feel safe, calm or understood. We use different care plans that can change and adapt to meet your loved one’s specific needs. This means the care they receive is flexible and tailored to what works best for them.

You can support the initial assessment by answering the registered nurse questions on the individual, bringing dedicated information packs, such as the “This is Me” passport (for people with significant memory loss, dementia, who become distressed or who can’t communicate their needs) if you have one, and pass it on to the care team looking after the individual or ask for one to complete. Do not forget to inform the team of any new information/changing behaviours on the person as soon as you notice.

Your insight makes all the difference – you know them best!

ETOC Intervention

Once the assessment is completed, the registered nurse will complete a personalised plan that all staff will follow. You can be involved in the making of the plan by informing the registered nurse or clinical support worker of yours and your loved ones wishes (they will pass it to the wider team). Once the plan is written, the registered nurse will aim to discuss this with you as soon as possible. We will engage the individual in completing with us the leaves of the “Care Tree” (please join us!). This is a simple visual collection of interest for the person receiving ETOC placed above the bed space, so anyone approaching knows what they like straight away!

Our teams use lots of different techniques to help keep patients safe and calm. These include things like talking and listening, using distraction, gently guiding someone to another activity, and (only if there’s an immediate and serious risk to the person or others) safe restraint by fully trained members of staff.

We will provide the individual with engaging activities for all tastes, including physical exercises, games (like crosswords, sudoku, etc.), Breathing Exercises (when most in distress) among many others.

Restraint

A restraint is any use or threat of force intended to make a person do something they are resisting or to stop them from doing something they wish to do. LTHT makes sure that restraints are only be used as a last resort, to prevent immediate harm, in the least restrictive manner possible. They are regularly reviewed (at least daily), always applied for a limited time and fully documented.

At times decisions regarding restraining someone may be made in person’s best interests if harm is felt likely to occur. This is always a last resort and only done in the person’s best interests, following the law and our professional guidelines. Whenever this happens, we make sure the right people are informed and involved in the decision.

Restraints can be psychological like telling someone they can’t leave or limiting choices, physical like blocking someone’s path when they are trying to leave, mechanical like using a falls sensor to prevent injury, or chemical like giving medication to keep someone calm. All restraints information is stored on our electronic records system, via a dedicated care plan for restraints.

Mental Health Professionals

If a patient is experiencing distress or potential risk of harm to themselves or others which may be related to a mental health condition, we will work with our mental health colleagues — such our Liaison Psychiatry services, as RMNs or Care Support Workers — to provide the most appropriate support.

Final Messages

We’re committed to keeping your loved one safe, comfortable, and well cared for during their stay at LTHT. Work with us to achieve this goal. Our team is here to support patients and families alike with kindness, respect, and understanding every step of the way.

If you have any questions or concerns, please speak to the Nurse in Charge or Ward Sister – we’re always here to help! Please remember that even if the person you talk to does not have all the answers you need, we can always refer to area specialists that can support your query.