Observation Levels
Observation levels define how frequently patients must be observed. Each patient is assigned a level based on their clinical needs.
Standard Levels
| Level | Interval | Description |
|---|---|---|
| Q5 | 5 minutes | High-acuity frequent monitoring |
| Q15 | 15 minutes | Standard observation for behavioral health |
| Q30 | 30 minutes | Less frequent monitoring |
| Q60 | 60 minutes | Hourly checks |
| 1:1 | Continuous | Constant observation (no gaps allowed) |
| Elopement | Continuous | Elopement precautions with geofence monitoring |
How Intervals Work
Observation intervals are measured from the last observation, not from a fixed schedule.
Example with Q15:
- Observation at 10:00
- Next observation due by 10:15
- If observed at 10:12, next due by 10:27
This allows for natural workflow variation while maintaining frequency requirements.
On-Time Calculation
An observation is considered on-time if documented within 1.5× the interval:
| Level | Interval | On-Time Threshold |
|---|---|---|
| Q5 | 5 min | 7.5 min |
| Q15 | 15 min | 22.5 min |
| Q30 | 30 min | 45 min |
| Q60 | 60 min | 90 min |
Beyond 1.5×, the observation is late but still valid. Beyond the interval + 50%, an overdue alert is created.
1:1 Observations
Continuous observation levels (1:1) have special requirements:
- Staff must remain with the patient continuously
- Any gap exceeding 5 minutes triggers a critical 1:1 Gap alert
- The Observe tab is replaced with a dedicated screen showing a coverage timer, activity strip, one-tap log templates, and a Request Break button (see 1:1 Continuous Observation)
- The device's screen stays awake while the 1:1 screen is open
- The duplicate-observation guard is relaxed for 1:1 patients (5-second window instead of 60 seconds) so legitimately frequent taps aren't blocked
- Relief handoffs are implicit: when the relief nurse logs the next observation, the requesting nurse can hand off and step away
Changing Observation Levels
Clinical staff change a patient's observation level in Settings → Patients, following the physician's order.
When a level changes:
- The new interval takes effect immediately
- Previous observations remain at their original level in history
- The change is recorded in the audit log with the old and new level and who made it
Applying observation level orders directly from the EMR is planned.
Elopement Level
The Elopement observation level is for patients at risk of leaving the facility:
- Requires a BLE wristband with configured geofence
- Geofence violations create immediate alerts
- Combined with a timed observation interval configured per patient