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Nurse study shows benefits of remote monitoring

Nurses at UC San Diego Health System have a new tool for falls prevention: portable remote video monitoring of patients at greatest risk. After a two-year pilot, Laura Vento, MSN, RN, CNL, interim nurse manager, and Paige Burtson, MSN, RN, NEA-BC, associate director of nursing medical surgical specialties, are convinced the remote monitoring improves safety for patients.

Laura Vento, RN

Laura Vento, RN

Vento and Burtson led the pilot study, starting in November 2012, using six video monitoring carts. After analyzing data, Burtson said the hospital is continuing with the program and adding two more carts.

She said the study was a response to increases in sitter use “which almost tripled in a few years, but when we investigated fall rates, they were consistently the same, even with more sitters.”

Pilot data

Data from the pilot demonstrated they could reduce sitter use and maintain or improve outcomes for falls or injuries, Burtson explained. “Overall rate of falls per 1,000 patient days ranged from 2.4-2.5 facility-wide” before the pilot. The second full year of implementation, the rate was 2.33 falls per 1,000 patient days.

Additionally, Vento said “the monitoring increased nurses’ awareness of what went on in patients’ rooms when nurses weren’t there. Nurses also have become more aware of the proximity of patients’ personal items, call bell, urinals and bed alarms, making sure they are accessible.

She said the video monitor techs provide nurses with insights into their patients after observing them through entire shifts. For example, the tech might hear a patient talking aloud about wanting to go home, leading to unsafe behaviors such as wandering.

Aside from falls prevention and wandering, the monitoring is useful with patients who are in isolation, are violent or impulsive — scenarios that put a sitter at risk, Burtson said.

Patient response to remote monitoring

One surprise, she said, was how responsive patients are to the two-way audio intervention. “We underestimated that. Patients who are moderately confused can often respond to the VMT asking them to stay in bed.”

Both Vento and Burtson said prior to the study, nurses feared their work flow would be negatively impacted by continual calls to respond to patient concerns. Instead, Vento said, “knowing their patients are safe has been a tremendous plus. It took time for the nurses to trust that this intervention works, and that the patients would respond to a voice when they can’t see the caregiver.”

P_Burtson_SNIP

Paige Burtson, RN

She said the program also promotes teamwork. If the VMT deems that the patient needs nursing intervention, the tech calls the nursing station and any available staff can intervene.

Most patient privacy concerns have been allayed, Vento said, by having the VMT meet patients during shift changes or rounds, and by explaining that no recordings are made.

In addition to hard data, the program’s success is evidenced by the waiting list to use the eight carts, Burtson said. As one of many tools for improving patient safety, video monitoring is a valuable option.

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[accordion title=”How video monitoring works” load=”hide”]The video monitoring pilot at UC San Diego Health System used portable carts, each with a camera on an IV-like pole. Connected to a secure wireless network, a cart is stationed in a patient’s room to provide real-time video, explained Lisbeth Votruba, MSN, RN, PCCN, vice president of clinical quality and innovation at vendor AvaSure.

Two-way audio is a significant element, Votruba said, allowing speaking between the trained video monitor technician and the patient.

The VMT monitors the patients from a remote site, inside or even outside the building where patients are roomed. Typically the VMT is a nursing assistant, who has been trained to use the technology; a VMT can monitor 10 to 12 patients per shift.

The effectiveness of the technology, Vento said, is that “there’s an actual person behind the voice and the intervention. A real person is individualizing care and responding to the patient.”[/accordion]
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By | 2015-12-21T20:44:00+00:00 December 18th, 2015|Categories: Nursing specialties, West|1 Comment

About the Author:

Karen Schmidt, RN, is a freelance writer.

One Comment

  1. Tonya Todd December 23, 2015 at 12:22 am - Reply

    Please tell us the manufacturer of video equipment and the perks involved to use their equipment. Did you shop around for different manufacturers? Did they approach you or did you approach them? Who funded the pilot? Who paid the nurse’s salaries to conduct study? How were these nurse’s regular duties met while they conducted this study? You stated the reason for this technology was increase in sitters, which still didn’t improve fall rate percentage. Maybe the hospital initially didn’t provide enough sitters or second time when sitters were increased. Need some hard numbers on theses facts…nurse patient ratios, nurse assistants to patient ratios, number of incident reports, state regulatory agencies of hospitals and licensed staff. Outcomes, warnings from evaluations made during state inspections, were falls a common factor? Finally how many family attorneys met with your legal department and are there any pending litigation regarding falls. Those in healthcare have known about the “baby boomer explosion,” that was coming. What hospitals prepared for it? You state this monitoring made the nurse more aware of their patients. Nurses do not sit and they don’t have time to sit and view their patients. You know that is the absolute truth, to add this statement, raises any validity to all of your findings. Did you hire additional staff and train them as monitoring techs or did you take some of the nursing assistants to fulfill these new positions? Patients who are determined moderately confused cannot consent. Your statement of patient “often,” can respond to tech. I would think someone who is confused would become more confused and frighten, hearing voices. The timing from when the tech notices a patient that needs attention, (after all you state the VMT will be monitoring up to 12 patients) and relays to nurse or to nurse station, which both are working relentlessly to meet other patients needs, is not realistic. The statement made, “In addition to hard data, the programs success is AEB by a waiting list. A waiting list is hard data? Is the list from other departments in your hospital or are other hospitals on this list? (I just saw it is AvaSure which is providing technology) Are you saying each room would have to have their own monitor? If so very expensive, how are patients charged. Will patient’s who insurance will not pay for this monitoring but the patient has been deemed, “moderately confused,” How will this patient’s safety be maintained? If they will not, what do you think families are going to accuse you of, discrimination is one accusation right of way. This study appears to not mention any of the gold standards of assessments. What it has conveyed to me as a registered nurse, is how desperate hospitals are, to increase profit margins by reducing “bedside nursing.” The Nursing Payroll is very attractive to corporations, because salaries of nurses are that which could mildly be significant to increased profit margins. Falls are going to happen AEB your findings and laughably the percentage noted in favor of monitoring. How could you even publish this study and your findings. HIPPA, I’m not going to even comment on. The most merciful thing you could do with this technology is to donate it to Alzheimer’s units. The most vulnerable part of our population that is physically, emotionally abused in every way not even having the respect we give to criminals AEB thousands and thousands of dollar on each patrol car technology to capture event not to mention billions of dollars spent for this technology in prisons. This is the most flagrant, frivolous study that you have conducted. “The effectiveness of the technology?” Reading this article is heart breaking for our patients. You will never replace nurses and you keep trying and succeeding, the healthcare corporation in which you work for could not ever proclaim quality healthcare, every lawsuit they encounter will be the nurse at the bedside evidence. I’m glad in one respect reading your article is I know who the vendor is and promote their technology as ludicrous. Ms. Vento and Ms. Burston shame on you for stating you’re nurses. You should be advocating for nurses at bed side and patients they are caring for. Don’t go down a fool’s trail by finding “innovative snake oil technology.”

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