Appendix D Observations of Long-term Segregation Instructions for the use of this form 15 minute observations unless otherwise agreed by the MDT but as a minimum at least every 60 minutes File this recording form in the patient’s notes Refer to the patient’s care plan for Long-term Segregation and ensure consistency of practice Patient Name Ward RiO Number Nurse Web based Incident Report number: REVIEWED : Signature/designation Signature/designation Time Risk Behaviour(s)/factors identified during of member of staff of member of staff Date Initiated observations carrying out carrying out receiving observations hand -over
Appendix D Observations of Long-term Segregation Instructions for the use of this form 15 minute observations unless otherwise agreed by the MDT but as a minimum at least every 60 minutes File this recording form in the patient’s notes Refer to the patient’s care plan for Long-term Segregation and ensure consistency of practice Patient Name Ward RiO Number Nurse Web based Incident Report number: REVIEWED : Date Time Initiated Risk Behaviour(s)/factors identified during observations Signature/designation of member of staff carrying out observations Signature/designation of member of staff carrying out receiving hand -over
SP-PGN-02-AppD-ObsOfLTS-Iss-2-Oct-17.docx