A Day at Brigham and Women’s: AvaSys and Patient-centered Care
It was a pleasure to spend the day in Boston Sept. 18 learning from Brigham and Women’s Continuous Virtual Monitoring team, which hosted a daylong conference entitled, “Using Virtual Monitors to Enhance Safety and Reduce Falls in Hospitals.” The team at Brigham and Women’s, a teaching affiliate of Harvard Medical School, discussed in-depth the hospital’s experience with the implementation of AvaSys continuous virtual monitoring as a patient safety initiative.
There is no question in my mind that this is an organization committed to relationship-based care. Not only are team members grounded in Jean Watson’s Theory of Human Caring, they have put that theory into action. For example, they included a patient advisor from the beginning of their planning stages in adopting AvaSys.
Over and over throughout the conference various speakers touched on not just patient privacy, but patient dignity as well. A highlight for everyone attending the symposium was a talk-show-style interview that included a patient and one of the video monitor techs who had participated in the patient’s care. This patient was able to share how intrusive it was to have a 1:1 sitter at his bedside. He got a big laugh when he explained how he felt he was responsible to entertain the sitter. He asked her if she wanted to play cards or watch a specific TV show. As a bedside nurse, I was taught not to think of the patients as guests in my hospital, but rather that I was the guest in their room. How awkward then to have an uninvited guest, a stranger just sitting and watching you around the clock! One doesn’t generally want even their closest friends to stay too long when visiting in the hospital! This patient then contrasted his experience with a sitter to continuous virtual monitoring. He was aware that in his condition that any fall would have been seriously detrimental. He explained how the AvaSys Monitoring Unit made him feel safe and was less invasive than the sitter. For him, it was much easier to forget about the video monitor tech watching over him, and yet he knew she would be there for him if he were to inadvertently do anything to put himself in danger. “If I wanted to be sure she was watching, all I had to do was start moving around in the bed. Trust me, I tested her.”
During the Q&A period, an audience member shared another patient-centered experience. Her uncle needed video monitoring during an episode of confusion he had in the hospital. “I can’t tell you how it made my aunt feel. They were married for 50 years. It was hard for her to get to (the hospital) to see him. She just felt like, ‘thank goodness he’s being watched. I don’t have to worry about him.'”
Another highlight of the day at Brigham and Women’s was the presentation by Leslie Delisle and Monique Mitchell. Both are certified psychiatric clinical nurse specialists who direct the Psychiatric Nurse Resource Service at the hospital. They addressed a practice question I’m frequently asked these days, “Does video monitoring work for patients in delirium?” I have personally seen patients in delirium respond very well to verbal redirection of the AvaSys monitor technicians, but I’m still waiting for a randomized control trial addressing video monitoring for delirium. In my experience as a clinical nurse specialist, I often ran into practice questions that didn’t have a definitive research answer. When that occurred, expert opinion was another valid form of evidence I knew I could rely on. These two nursing experts generously shared the positive outcomes they were seeing with delirium and how they educated their continuous virtual monitor technicians on the most appropriate verbal techniques for communicating with these challenging patients. They concluded their presentation with their expert opinion that continuous virtual monitoring is a great option to monitor patient safety.
Brigham and Women’s is committed to relationship-based care. Team members presented their experiences from every aspect of the program. This is a group of professionals at the top of their game, working together to achieve something truly innovative in patient safety.
Deborah Farina Mulloy, PhD, CNOR Associate Chief Nurse, concluded the day by sharing impressive outcomes with reductions in falls and falls with injuries across all four pilot units. The reduction in the rate of falls with injury ranged from 43% to 100%. They are continuing to expand the units where videomonitoring is used.