The most effective means to provide around-the-clock care for an acutely ill patient is deploying a multidisciplinary team of caregivers. For organizations that have adopted the AvaSure TeleSitter® Solution, the AvaSure Monitor Tech (AMT) has become the latest addition to the team. Physicians, nurses, physical therapists, respiratory therapists, pharmacists and case managers each provide valuable information based on their assessments and interactions with the patient. Working together, they monitor every aspect of care, ensuring a positive outcome.
The AvaSure Monitor Technician (AMT) has allowed your team of caregivers the ability to afford another level of patient and caregiver safety. Other caregivers simply cannot be in the patient’s room all the time and they need the kind of feedback that only a trained technician with eyes and ears on the patient can provide.
This is something new for most organizations, which is why we must learn to trust the AMT.
Here are a few ideas to smooth this transition and make the most of this new team member:
- Have the Monitor Tech actively ensure that universal fall precautions are in place, along with providing supplemental hourly rounding from the central monitoring station. By systematically panning the camera around the patient room, utilizing the zoom features if needed, the AMT can recognize an unsafe environment such as if the call light is out of reach or a bed rail is left down. During these purposeful rounds, the AMT can also observe the patient using the 5 Ps strategy, even verbally talking to the patient if appropriate. This can be documented, and if an exception to the standard is found, a caregiver notified.
- Use the Monitor Tech for activity and/or behavior reporting to staff. The monitor technician develops a unique perspective while watching patients 24/7. He or she quickly comes to recognize cause and effect behavior, discrete signs of change, and signs of agitation or discomfort. Not only does this provide the opportunity for immediate and early intervention in cases of at-risk behavior, the AMT can also note if these signs are occurring more or less frequently or are changing, things a nurse might not notice even with frequent rounding.
- Glean information from retrospective reporting on an adverse event. By interviewing the AMT, the other members of the care team can obtain information about what was seen prior to an event, such as changes in the patient’s behavior, activity in the room or the patient’s condition. This information may not have been previously obtainable, which may contribute to developing the best intervention possible for that patient.
- Enlist the Monitor Tech to help improve the safety of patients and/or caregivers. The monitor tech has a 24/7 view into the room, and, if directed by caregivers, can keep watch for certain situations that could be hidden from staff doing traditional hourly rounding. Those might include violent family members or visitors, patient self-harm, patients attacking staff and the presence of illegal substances. Quite often, AvaSure Monitor Techs have helped rescue a staff member by alerting security of dangerous actions occurring in a room. They have also prevented patient elopement.
It is essential to create a process flow that allows regular and purposeful communication between the direct patient caregivers and the AvaSure Monitor Technician. Care should be taken to streamline this process into existing documentation and care planning. The clinical staff should be educated on the contributions the AMT can provide the care team during monitoring. Some ideas for streamlining this collaboration include:
- Verbal or written reporting to nurses. The AMT and RN should communicate verbally one hour before the end of each shift and as needed regarding monitored patients. A systematic subjective report of patient behaviors and status throughout the shift should be documented by the RN in the EMR based on a collaboration of nurse and monitor tech. This information should be used in daily huddles to help caregivers assess the patient’s safety risk, identify the continued level of monitoring needed, and to make triaging and staffing decisions.
- Monitor Techs documenting in the electronic medical record. The monitor tech can document directly into an EMR so caregivers can have real-time information when needed. Documentation flow sheets in the EMR should be easy to access and use so the AMT does not have to take eyes off of the monitoring screen for long periods of time. Real-time checklists and end-of-shift reporting have been effective.
- New software called AvaSys 2018 allows the Monitor Tech to document events in real time. AvaSys 2018 has advanced functionality that captures the occurrence and avoidance of adverse events (aka “near misses”). With just a couple of mouse clicks, monitoring staff can quickly capture when an adverse event such as a fall occurs, without sacrificing close vigilance on other patients. This data allows organizations to compare performance against national benchmarks.
- Establish an open communication line to security in the event a patient engages in risky or illegal behavior. The criteria to watch for should be provided to the AMT by the nursing team. The appropriate notification protocol should include not only contacting the caregiver on the unit but making a call to security as well.
- Give physicians, case managers and nurses the chance to come to the monitoring station to interview AMTs or watch patients themselves if needed. The monitor tech’s subjective knowledge and hourly behavior and activity documentation of monitored patients can be useful for care planning, discharge planning and treatment investigation.
The AvaSure Monitor Technician is a new member of the care team. Use some or all of these best practices to make the most of this new technology and clinical role to improve patient and caregiver safety and patient outcomes. And let us at AvaSure know how you are doing.
Stacey Overholt, VP, Client Services, AvaSure
*Original publication on March 2015: Update April 2019 by AvaSure LLC
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