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Earlier this summer I attended a webinar presented by the National Quality Partners Action Team to Prevent Healthcare Workplace Violence. The group includes representatives of healthcare organizations such as Cleveland Clinic Lutheran Hospital and the Department of Veterans Affairs and professional organizations such as the Emergency Nurses Association and the American Nurses Association. The team was convened by the National Quality Forum in October 2019 to increase awareness about the need to improve healthcare worker safety.

The event was edifying and covered a lot of familiar ground, but something was missing: A solution that actually prevents abuse of staff.

The National Institute for Occupational Safety and Health defines workplace violence as physical assault, threatening behaviors and/or verbal abuse towards persons at work or on duty. Healthcare workers are four times more likely to suffer violence than workers in other industries. Evidence shows workplace violence is tremendously under-reported by nurses. Hospital leaders are challenged on how to address the problem.

During the webinar, the presenters addressed the physical and emotional harm, stress, and cost of threats and assaults on health workers. In addition, the panel addressed the many challenges to identifying, tracking, trending and preventing workplace violence. The panelists outlined four recommendations for change: standardizing definitions and data collecting, analyzing and sharing data, investing in safety, and collaborating and scaling efforts. (For more, see the team’s recent issue brief.)

Interventions offered include incident reporting, data collection and greater transparency. However, much research confirms that reporting episodes of violence in the workplace is dependent on nurses’ filing reports to hospital leaderships. Given that nurses believe little will be done to reduce workplace assaults in response to such reports, transparency is unlikely to improve simply by wishing it were better.

As I listened, I waited (in vain) for this newly formed action team to inform the audience of the proven success of remote safety monitoring in capturing, trending and tracking actual patient assaults on nurses, and the success of monitoring staff in both warning nursing staff about potentially problematic patients and using audio interventions to de-escalate situations that develop.

Technology such as this is not exactly new to healthcare systems. Remote safety monitoring has demonstrated results on patient outcomes for over a decade, and now there is published evidence of its effectiveness in preventing attacks on staff as well as accurately collecting, classifying, tracking and trending reliable data.

I should know, as I co-authored two large-scale national descriptive correlation studies on this issue with Lisbeth Votruba and Jill Kaminski. We used AvaSure’s Online Reporting of Nursing Analytics (ORNA) tool, a cloud-based data program that documents comparative efficacy by a host of different parameters, including by hospital, hospital systems, unit, patient and patient condition.

One of those articles, published last December in American Nurse Today, describes the value of AvaSure in documenting, trending and preventing workplace safety incidents. Reviewing the ORNA database, the article found that over a year, monitor staff reported witnessing 136 incidents of verbal and physical abuse of staff. Another 5,458 events were prevented by the intervention of the monitor technician, 90% of them by verbal intervention alone.

Another study published late in 2019 in the Journal of Nursing Care Quality found that monitor staff intervened to avoid 40 workplace violence events for every one that occurred – a 97% reduction.

After hearing about and reading about violence against nurses for most of my career, this data is music to my ears. I encourage every healthcare leader and health system board member to read those articles and act on them, committing to preventing physical and emotional violence against the people who work for you by investing in proven technology and programs and NOT relying on workforce staff reports or incident reports filed long after events have occurred.

Patricia A. Quigley, PhD, MPH, MS, APRN, is a nurse consultant, AvaSure Advisor and a leading expert on patient falls.

Hundreds of clients have taken up AvaSure’s offer of a free, temporary software license to establish separate command centers from which clinical staff can continuously visualize and communicate with coronavirus patients spread out across hospitals from the emergency department to isolation rooms to the intensive care unit. In some hotspots, clients are adding more mobile devices to their networks.

This new use of remote safety monitoring serves multiple purposes, including reducing caregiver close encounters with infected patients, slowing the burn rate of scarce personal protective equipment and improving communication among caregivers, patients and families.

When an alarm sounds from a pulse oximeter or infusion pump, the monitor is able to establish whether or not there is a need to enter an isolation room. The same goes for routine patient requests that are non-urgent, avoiding staff having to put on gloves, gowns, masks and face shields to respond, only to have to throw most of it away minutes later while having taken a needless risk of exposure.

“Having a camera and audio in the room allows the monitor to respond to alarms from medical equipment that are more often in error than not,” notes AvaSure founder and CEO Brad Playford. “Also, it allows for much more frequent interaction with quarantined patients who are not in ICU and on ventilation. Often, these patients are lonely as well as sick, as their families cannot visit in person.”

A few hospitals have established what are being called “compassion stations,” where loved ones can safely say farewell to the terminally ill.

Among the other benefits has been at least some consolation for weary caregivers. In hospitals in hotspots like New York, Seattle and Detroit, there is a psychological benefit just in letting caregivers know that new resources are on their way.

AvaSure has been in conversations with legislative leaders in Washington, proposing legislation Playford calls the Caregiver Defense Act to provide funding for more devices and monitor staff. “Lawmakers could show immediate support and stand up for our nation’s frontline clinical staff – who are putting their lives on the line to save victims of this pandemic – and provide matching funds for hospital systems to add more remote monitoring capabilities to their existing networks,” he said. Alternatively, some funds from either earlier legislation or a fourth stimulus bill could be appropriated for this purpose, he added.

“Whatever happens, we at AvaSure are proud to once again see our clients innovating in how they use the ever-adaptable resource known as the TeleSitter for such an important purpose,” Playford said. “If we at AvaSure are able to play even a small role in keeping staff and patients safer during this crisis, it will be something none of us ever forget.”

Contact us at info@avasure.com or call 800.736.1784.

There seems to be a cultural belief that abuse is just part of the job; many staff don’t report it because they don’t believe anything will be done about it. Only a few states have enacted legislation creating a process for reporting such data.

AvaSure’s initial uses were for fall prevention and sitter reduction. However, we soon heard anecdotal reports of nurses using the solution to keep caregivers safe. Following the lead of customers, AvaSure designed and released a new software version in 2016 that allowed monitoring staff to document witnessed physical or verbal abuse events, as well as “near miss” incidents where they believed they prevented an injury to bedside caregivers.

In 2018 there were 71 hospitals that documented abuse events. Abusive behavior may occur between patient and caregiver, visitor to caregiver, patient to visitor, or visitor to patient.

AvaSure adviser Patricia A. Quigley, Jill Kaminski, our Clinical Data and Systems Analyst, and I co-authored an article analyzing these events, which will be published in American Nurse Today later this year. 

Major findings include:

• Nursing judgment alone is not that sensitive or specific for identifying which patients will be violent – most of the patients that perpetrated violence on caregivers were being monitored for fall prevention
• 11% of the verbal abuse reported was a threat to kill the caregiver
• For every abuse event reported, monitoring staff reported avoiding 40 events mainly through verbally redirecting patients

Based on our results, we can suggest that AvaSure program managers:

• Review their hospital’s observation policy to place patients who are aggressive/violent on the TeleSitter. Many of these patients present in the emergency department, and video monitoring can provide staff safety for not only the clinical staff but ancillary staff as well.
• Train monitoring staff to recognize escalating aggressive behavior to proactively identify issues before they lead to a violent event.
• If a patient’s aggressive behavior requires a one-on-one observation, consider utilizing a monitoring device in the room as a backup to provide safety for the sitter.

As more and more hospitals adopt AvaSure and take advantage of the software to track abuse of staff, we hope to shed new light on this issue and spur action to keep frontline staff safe.

Lisbeth Votruba, MSN, RN, is Vice President of Clinical Quality and Innovation at AvaSure

Many hospitals have taken advantage of AvaSure’s offer of an additional, free monitor station software licenses, which allows healthcare facilities to establish additional localized command centers, empowering clinical bedside staff to view and communicate with COVID-19 patients. With COVID-19 still spreading across parts of the U.S., AvaSure has extended the timeframe for using these licenses until January 31, 2021. If you have not already contacted AvaSure to receive a free license, please notify us.

During this pandemic, many hospitals have deployed the TeleSitter® solution to COVID-19 patients to avoid the spread of the virus and make better use of scarce resources such as masks and gowns. Using the mobile TeleSitter®, which has both high-resolution video and two-way audio to the patient room, allows remote staff to continuously visualize and communicate with patients from the emergency department to isolation rooms to the intensive care unit. Nurses and doctors can remotely interact with the patient to help decrease the frequency of times they must put on and take off personal protective equipment (PPE). Patients suspected of highly contagious diseases are moved quickly from the emergency department to isolation rooms or the ICU. As these patients become spread out in the hospital, monitoring them both centrally from a command center and more locally at the nurses station, frees providers and infection control staff from unnecessary exposure while increasing patient interactions.

Our goal is to help reduce stress on caregivers, patients and families affected by the current situation. We are here to provide a helping hand in these uncertain times.

The latest version of the American Hospital Association Health Research & Educational Trust’s Falls With Injury Change Package introduces video surveillance as a change idea to increase the intensity and frequency of patient observation. HRET recommends video surveillance using a remote monitor tech who can speak with the patient and alert staff directly to intervene with the patient (p. 6 and p. 21).

In a new research study published in the September issue of the Journal of Nursing Care Quality, Lauraine Spano-Szekely, the Chief Nursing Officer of 245-bed Northern Westchester Hospital in Mt. Kisco, N.Y., and colleagues conducted an evidence-based improvement model for fall prevention that included:

• Organizational support for a fall prevention program
• Injury assessment
• Mobility assessment
• Assessment of medications that increase fall risk
• Consistent communication of risk factors
• Purposeful hourly rounding

Through small tests of change, program evaluation revealed a decreasing fall rate, except in the geriatric cluster of patients with confusion and impulsivity. Seeking evidence of cost effective-safety promotion technology for confused and impulsive patients to replace patient sitters, this research team implemented AvaSys, a patient-engaged video monitoring system. Through it, the team realized a 54% reduction in falls and a 72% reduction in sitter usage.

Their article, “Individualized Fall Prevention Program in an Acute Care Setting: An Evidence-Based Practice Improvement,” presents a population-based approach to fall prevention that also captures the “good catch” – when a fall was actually prevented because staff intervened. Interventions to protect geriatric, confused and impulsive patients from falls ultimately prevent injuries and save lives.

This new work stands in stark contrast to much of our previous experience with call lights, bed alarms, signage and sitter use, none of which moved the needle in any significant way on either falls or falls with injury, a wide array of studies have shown.

Given new information, we all need to stop over-reliance on universal fall precautions and start individualized and population-specific fall prevention programs. This research continues to confirm AvaSys’ effectiveness in patient safety and population-based outcomes.

Author:
Patricia A. Quigley, PhD, ARNP, CRRN, FAAN, FAANP, is a nursing consultant and a nationally recognized expert in fall prevention. 

This marks our third consecutive year that we have honored organizations for achievement in making remote video patient monitoring a vital tool in patient and staff safety, nursing efficiency and cost control.

The honors include the Safety Net Award for the most complete AvaSys program; the Path to Zero Award for the most impressive fall reduction program centered around video monitoring; the Hub and Spoke Award, for the most efficient use of AvaSys by multi-site organizations using a single remote central observation center; and the Video Monitor Staff Superstar Award, which recognizes an individual who consistently goes above and beyond to ensure the safety of patients and staff.