The use of constant observation for people with dementia in hospitals: a systematic review

Abstract

AbstractBackgroundConstant observation is a model of care used in hospitals to manage a patient’s safety. For people with dementia this is often due to a risk of falling or from displaying behaviours considered to carry a risk of harm. Person‐centred approaches are recognised as best practice for people with dementia, but this can be difficult to achieve for staff providing constant observation in hospital settings. It is therefore important to understand how person‐centred principles can underpin the use constant observation.MethodA mixed‐methods systematic review was conducted to understand how and why constant observation is used for people with dementia in hospital, how effectiveness is measured and what enables staff to use a person‐centred approach.Electronic databases (Medline (PubMed), CINHAL, Psychinfo, and The Cochrane Library) were searched between 2010 – 2022. Screening and data extraction were completed against eligibility criteria, with 20% double screened and extracted for consistency. Narrative synthesis combined qualitative and quantitative findings.ResultTwenty‐four studies were included, reporting findings from 14 intervention studies and ten studies of constant observation practices. Constant observation for people with dementia was often provided by non‐registered staff without specific training for the role. Assessments and processes for assigning constant observation helped clarify the level of observation required and encouraged regular review that linked initiation and discontinuation to a patient’s changing needs. Examples of person‐centred care were mainly derived from studies of volunteers or staff employed to provide activities. These demonstrated that meaningful engagement could reassure a person and improve their mood. Proactive approaches that anticipated a person’s distress were thought to reduce behaviours that carried a risk of harm but supporting evidence was lacking.ConclusionA proactive, person‐centred approach to constant observation is accepted as beneficial for people living with dementia. The reliance on non‐registered staff limited by organisational efforts to reduce risk leads to responses focused on containment. When staff are trained and supported during constant observation, they can connect with patients and provide comfort, potentially reducing behaviours that carry a risk of harm. Aligning patient, staff and organisational priorities will likely improve the inpatient experience of people living with dementia.