Enhanced Care

Being admitted to hospital can be a disorientating and distressing experience for a person you care for and they may require a closer level of observation whilst in hospital. The person you care for may have complex physical and emotional health needs. Enhanced care can be a beneficial intervention to manage risk and reduce distress whilst focussing on patient centred care.

Enhanced care is a closer level of supervision used when staff have risk assessed the potential harm to your relative or the person you care for, or the risk to others. This means that they will be closely observed to maintain their safety, privacy and dignity. The level of observation will be determined through a risk assessment process.

A person may require enhanced care because:

• they may be at risk of falls
• they may be pulling out lines or tubes that may result in harm
• they may be confused, distressed or agitated
• they may have dementia /delirium or cognitive impairment
• they may be attempting to cause harm to self or others
• they may have mental health concerns which impairs their ability to keep themselves safe
• they may have a learning disability which impairs their ability to keep themselves safe

The requirement of Enhanced Care will be reviewed every 12 hours by a registered nurse. Here they will determine the level of risk to the person you care for and the appropriate level of observation will be maintained.

What are the types of observation?

• routine supervision – staff provide routine two hourly checks during the day and night regarding the whereabouts and well-being of all patients on the ward
• low risk – intermittent observation and supervision maintaining half-hourly observation, this can be de-escalated to one hourly if no concerns.
• medium risk – continuous supervision (within eyesight) one nurse per room
• high risk – continuous one to one supervision. The nurse providing one to one care must be able to see the person you care for at all times. This level of care may be needed all the time, day and night or just for certain periods of time -  if there is a pattern of behaviour. The staff member providing this care will provide supervision on a one to one basis and encourage the person you care for to engage in simple activities and provide reassurance and comfort

• low risk – routine visiting
• medium risk – you will be given information regarding the rationale for the Enhanced Care. During visiting, staff supervision may be reduced at the discretion of the nurse in charge however we ask that when you leave, that you inform staff so supervision can be resumed
• high risk – whilst you are visiting with the person you care for the nurse providing 1 to 1 supervision will continue unless agreed by the nurse in charge

Am I allowed to stay with the person I care for whilst they are getting enhanced care?

We know patients can benefit from having people around them that they know. We are keen to support relatives and carers who would like to be involved in their care. If you wish to be involved with the person you care for please speak to the Nurse in Charge.

The hospital supports John's Campaign and the Butterfly Scheme (for more information on these initiatives, please speak to the Nurse in Charge).

Staff may discuss the following with you:

• what care you usually provide?
• what do you feel you are able to do or not to do?
• does your relative/person you care for have any special equipment which can be brought in?
• is there any other valuable information you can tell us? (e.g. likes, dislikes etc)

Staff may also explain:

• how much care you safely can be involved in
• any limits or restrictions due to current medical condition
• infection control procedures
• confidentiality – carers may be asked to leave the room during handovers or ward rounds involving other patients

Questions and further support

For questions or further support regarding enhanced care please see the nurse in charge or lead nurse for the ward.