Category: Uncategorized

Beyond TeleSitting: Virtual Nursing is Getting Real

Posted on September 14, 2021 by SuperScoutTrooper - Uncategorized

A recent trip to UCHealth’s Virtual Health Center in Aurora, CO, gave me and a colleague a breathtaking view of AvaSure as an indispensable part of healthcare delivery. From a central observation facility, this multi-hospital system is keeping patients safe at the bedside, validating telemetry alarms and supporting ICU teams in delivering critical care. In the early stages of COVID, its Virtual Health Center collected and disseminated the latest evidence-based treatment options to frontline staff who barely had time to sleep, much less review clinical research.

We at AvaSure have been planning for these new use cases, but to see them in full flight was inspiring for me and my colleague, Crystal Harding. We could see some of the seams in what the system was doing, but it was real, bringing home the potential of AvaSure to support critical care nurses and technicians as they seek to improve quality, make the highest use of staff resources and take some of the feelings of isolation out of isolation care.

We have names for these new services, but what we are doing is essentially extending the same proven technology that for a decade has been preventing bedside disasters such as falls to provide new layers of virtual care.

Here is some of what we saw on our trip:

The Virtual Health Center has three rooms. In one, five monitor techs were each watching a dozen med-surg patients for the “traditional” risks such as falling, eloping and pulling at lines and tubes. Staff were part of a research protocol on patient selection for remote monitoring. The room was mostly quiet while I was there, though I did witness an intervention to stop a traumatic brain injury patient from trying to go to the bathroom without staff help.
The telemetry room was quite a contrast. It was monitoring 500 patients from multiple workstations. Audible alarms were a constant. As I walked through the room, I imagined the staff hearing those alarms in their sleep.
The front room is the Virtual ICU, where three critical care nurses were using our technology, known as Verify, to watch over patients in all of this system’s hospitals. During night shifts, when physicians at the hospitals may not be as readily accessible, an intensivist physician joins the expert nurses in monitoring care. Verify uses AvaSure’s technology, but instead of a dozen patient rooms on screen, there are 38. Using a variety of physiologic monitors, the team can respond to the most at-risk patients based on bedside nurses’ concern or electronic trigger tools such as sepsis alerts and early warning scores, as well as visually rounding on the ICU patients.
Sepsis is a great example of the success of this approach. The health system has implemented a state-of-the-art sepsis care bundle. Changes in lactic acid levels, blood pressure and heart rate trigger an intervention, as sepsis treatment is so time sensitive. I was told of a novice nurse in one of the system’s smaller facilities who was not administering antibiotics in a timely manner to a patient in danger of slipping into septic shock. The patient had pulled out the IV and the new nurse had not been able to re-insert it. The virtual nurse found the resource needed to get the IV back in and antibiotics delivered quickly.
One of the nurses told me a story of how she witnessed a patient being coded for full cardiac arrest. She noticed that no one in the room was recording the medications given, so she took on the role of virtual recorder. There is an Advanced Cardiac Life Support algorithm that should be followed during a code. She was able to help make sure the team stayed on track. She told me: “I called into the room and reminded everyone, ‘It’s been two minutes since we last gave epinephrine; let’s give another dose now.’”

My colleague and I left our visit so inspired by the work this UCHealth is doing to keep patients safe. When the nurse told me this story, I had a lightbulb moment. While our TeleSitter® application helps keep patients physically safe, Verify is a wonderful tool for clinical safety.

All of this reminded me of a conference presentation I attended pre-COVID about virtual ICUs and the need for faster responses to “triggers,” or changes in physiologic conditions that are most closely tied to the danger of a life-threatening event. The presenters discussed how a bedside nurse has to open the electronic health record to receive one of these triggers, which might not happen if the nurse is occupied talking to a patient’s family or changing a dressing. With a virtual care team in place, the trigger generates an instant response.

The broader role we have envisioned for AvaSure is being actualized on the frontlines of care. We developed the tools, but nurses, doctors and monitoring staff are inspiring us by using them to improve the quality as well as the safety of care.

Remote Safety Monitoring Helps Address Pediatric Health Crisis

Posted on August 30, 2021 by SuperScoutTrooper - Uncategorized

COVID-19 has had a devastating impact on children. Many have experienced profound social isolation as a result of lockdowns and remote learning; others have had their home lives shattered by the death or debilitating illness of a parent or abuse by a family member. Even before the pandemic, suicide was the second-leading cause of death among adolescents; from 2007 to 2017 rates of teen suicide increased by 56%. After COVID took hold, the proportion of children seeking emergency mental health services who required immediate hospitalization rose 75%.

Suffice it to say, capacity to treat this need, including by inpatient children’s hospitals and within pediatric units of acute hospitals, has been tested. Nurse leaders are seeking solutions that will help keep patients safer while improving productivity, especially by reducing reliance on one-to-one sitters.

One solution that has shown promise for this challenging population is remote patient safety monitoring. Over the past three years, more than 4,000 pediatric patients have been placed under video surveillance using AvaSure’s TeleSitter® solution. Fifty-seven percent of those patients present with low- to moderate-risk suicide ideation. The other 43% are placed on video monitoring for the prevention of elopement, falls, medical device interference and staff injury prevention.

The TeleSitter® solution includes in-room monitoring devices with high-resolution video and digital audio, an invisible and automatic infrared light for low-light viewing and a virtual privacy curtain activated by the monitor staff when a caregiver is working with the patient. Room devices are either mobile (wired or wireless) or a permanent ceiling installation. The camera has 360-degree pan, tilt, zoom capability, allowing it to see minute details such as whether a patient is hiding something to be used later as a ligature. Each device is equipped with a loud and distinctive alarm used to alert staff that a patient is not responding to redirection or needs assistance. The average response time to the alarms nationally is 15 seconds.

The room devices connect via Enterprise software with centralized monitoring located in one hospital or in “hub and spoke” arrangements, with systemwide or regional centers watching patients in multiple hospitals, each tech with 12-16 patients on a large screen at their workstation.

Helen DeVos Children’s Hospital in Grand Rapids, Michigan, had been using AvaSure for several years to reduce the use of safety attendants, also known as patient sitters. Later it was used to monitor pediatric patients considered to be risks for aggression and violence against staff and other patients.

As the need has grown, Helen DeVos Children’s has used TeleSitting to monitor suicide-risk patients. The hospital uses the Columbia Suicide Severity Rating Scale to screen patients who present as moderate risk of self-harm or harm to others.

Joint Commission regulations say that patients with low-to-moderate suicidal ideation must be placed under “demonstrably reliable monitoring,” a standard that can be met by “continuously monitored video” linked to the “provision of immediate intervention” by a qualified staff member when called for.

At Anne Arundel Medical Center in Annapolis, Maryland, the pediatric patient selection criteria are different from adults’. It uses the Joint Commission-validated, four-question Ask Suicide-Screening Questions (ASQ) tool to assess the level of risk the patient presents. If the patient is found to be low-to-moderate risk, he or she qualifies for telemonitoring. Though the hospital also monitors adult patients, staff are given specific training on handling pediatric patients.

One key factor in a hospital’s degree of success in adopting this solution is the effort expended on overcoming institutional resistance to change. With suicide ideation patients, providers are often adamant that a human sitter needs to be in the room at all times, even though the vast preponderance of clinical evidence shows inconsistent results, as many sitters have no medical knowledge or specific training. If sitters are not available, direct patient care staff, such as patient care technicians, are de facto sitters. Once nursing leaders see the benefit of keeping frontline staff at the bedside, the more patients are remotely monitored.

Helen DeVos Children’s has worked on establishing strong communication between the nursing staff and monitor staff to tailor the intervention to each patient’s need. One patient may be restricted to bed, while the next is allowed to get up and sit in a chair. If a patient starts pacing the room and/or exhibits signs of anxiety, the monitor tech will intervene.

For parents, video monitoring means there isn’t a stranger sitting in the room staring at their vulnerable child. Parents are also happy to learn that the video is not recording.

Another best practice is for the monitor staff to greet each patient and family through the audio, so they know a human being is watching over their child. They use a scripted introduction, letting the family know they are there to keep their child safe. We think of it as akin to “the face behind the camera.

Last, but not least, there are the savings. As so many other organizations have discovered, monitoring 12 at-risk patients remotely versus using one-to-one sitters naturally lowers costs. Sitters are a little-known source of spending that can cost a health system millions of dollars annually.

For example, in the first 11,000 hours of monitoring of pediatric patients, Anne Arundel saved $212,000. Along with greater savings at the hospital level, this creates resources that can be put to better use in improving patient care.

Authors:

Jamie Clendenin, BSN, RN-BC, is Supervisor, Nursing Operations, Anne Arundel Medical Center, Annapolis, Maryland
Melanie Lee, MSN, RN, CPN, is Clinical Director, Pediatric Emergency and Inpatient Unit, Anne Arundel Medical Center
Ashleigh Nurski, MSN, RN, ACCNS-P, CPN, is Clinical Nurse Specialist, Helen DeVos Children’s Hospital, Grand Rapids, Michigan
Stacey Overholt, RN, MBA is Clinical Director of Sales at AvaSure.

The TeleSitter® Solution: What’s New and Where It’s Heading

Posted on June 7, 2021 by SuperScoutTrooper - Uncategorized

nurse on computer using AvaSure virtual care

To share research results in three recent national studies on the use of the TeleSitter® solution, AvaSure recently hosted Telesitter: What’s New and Where it’s Heading, a webinar attended by over 500 chief nursing officers from all 50 states plus Washington, D.C., including VAs from around the country. The webinar was presented by AvaSure’s Chief Innovation Officer Lisbeth Votruba, MSN, RN, and Nurse Consultant Patricia Quigley, PhD.

Their studies on Patient Engaged Video Surveillance (PEVS) based on AvaSure’s Online Reporting Of Nursing Analytics (ORNA), the groundbreaking research is clear:

PEVS is clinically proven to foster significantly safer hospital environments for patients and caregivers
In addition to considerable cost savings with the use of PEVS, perhaps the most telling outcome of the studies is the substantial improvement in safety for patients in witnessed events.
Prevent Falls
In Falls Prevention, the 12-month study of 71 hospitals and 15,021 patients considered as high risk for fall by nursing staff, shows that with PEVS, falls were reduced to .38 falls/1000 patient days of surveillance.

“This is getting to zero, where falls hardly exist,” Quigley said. The study revealed that hospitals equipped with PEVS saw:

A savings of 453 annualized FTEs typically used for traditional sitting, representing over 943,000 hours
A 92 percent reduction to 38 FTEs to monitor PEVS

Improving nurse safety against violence
The second study focused on violence against nursing workforce.

“While industry principles, OSHA guidelines and Joint Commission challenges to reduce sentinel events have been published in the past few years, there hasn’t been much improvement in reducing violence,” said Votruba.

This study included 300 witnessed events, 15,434 patients in 73 hospitals over a 21-month period to learn impact of PEVS on nursing workforce safety. The study found that with PEVS, for every abusive event witnessed, 25 were reported, including usually non-recorded verbal incidents.

And while most of the patients in this study were being monitored for fall prevention, and not violence, Votruba noted that these findings present an opportunity for more research on how to identify which patients might have the tendency to become violent.

Using PEVS for COVID-19 isolation patients
The third study, by Quigley, Votruba and Jill Kaminski just released in MedSurg Nursing, focused on PEVS for COVID-19’s acute isolation population, monitoring 1,625 patients in 97 hospitals over a two-month (March-April 2020), and representing 98,918 hours of observation.

Key findings included:

42 witnessed adverse events experienced among 39 patients
29 of the events involved a dislodgement of lines
9 falls (one unassisted)
2 self-harm events
2 physical abuse toward nursing events
while response time was lowered due to the donning of PPE, there were more verbal interactions per day to comfort isolated patients during this surge period

These studies show that real-time surveillance at the point of care is cost-effective, improves safety and is easily adoptable by nurses. Nurses were resourceful in fast-tracking the technology in the early weeks of the COVID-19 pandemic as they were pulling from as many resources as they could at the height of the surge.

Lisbeth also shared highlights from several studies she recommends for further reading as CNOs consider the technology for their hospitals. Those studies are linked below for further reading.

AvaSure is working hard to advocate that PEVS programs be a workplace safety initiative through the American Nursing Association.

A New Era. A Safer Way to Do Healthcare

Posted on January 25, 2021 by SuperScoutTrooper - Uncategorized

The pandemic of 2019 – 2021 has worsened existing shortages of nurses and other frontline personnel. With the labor pipeline not up to the challenge of replacing the baby boom generation in either the short or long term, healthcare organizations must adapt, or quality of care will suffer.

AvaSure is now offering a promotion on its permanent Guardian® ceiling devices at volume to help prepare for this new era of healthcare. We are also expediting the rollout process to meet the public health emergency, providing an immediate workforce multiplier for hospitals. The decision is made easier through AvaSure’s subscription program, which as an operational expense requires zero capital investment.

Healthcare is headed toward a more interactive future. Now is the time to embrace a system that offers continuous and/or episodic video-supported interactions.

Please contact us today to learn more about this promotion.

AvaSure Virtual Symposium Recap – Day 2, September 24

Posted on September 25, 2020 by SuperScoutTrooper - Uncategorized

On September 24, AvaSure held the second day of its virtual National Symposium. Health care experts from across the United States gathered again to network and learn from each other on their experiences with continuous remote safety monitoring. The symposium topics on day two were mindful of this year’s theme, Leading Through Change, and made way for caregivers to collaborate and present best practices when utilizing the telehealth platform and providing the best care for their patients.

Panel 4 – Lessons Learned Monitoring the Monitors
The first panel of the day, Lessons Learned Monitoring the Monitors, brought together the AvaSure TeleSitter program managers from Covenant Health, Ascension St. Joseph Hospital, VA North Texas Health Care System and Oregon Health & Science University. The discussion was moderated by Wendy Popma-Breen, RN, BS, BSN AvaSure Clinical Program Specialist.

The TeleSitter program managers shared insights on best practices, tips for enculturation, utilization of the technology and more. Experts provided meaningful advice as learned from hands-on experience in leading monitoring staff teams, including insight on a wide range of use cases such as with patients who have COVID-19, are suicidal or at-risk of falling. Additionally, extensive insight was provided as it pertains to the staff who are in charge of monitoring the patients, such as ensuring they are appropriately trained, collaborate in teams with helpful feedback and take ample breaks so they are in a good headspace.

We learned that not only do these hospital systems utilize AvaSure’s technology for day-to-day monitoring of patients that qualify for inpatient TeleSitters, they spend time as teams to review the ORNA data the platform provides. By reviewing the data, the networks are able to accurately make decisions when expanding the application of continuous remote safety monitoring, how its use saves the hospital systems on operational costs, output the value with specified metrics, and more.

Panel 5 – Preventing Self-Harm, Remotely
The second panel of the day was moderated by AvaSure’s Vice President of Clinical Quality & Innovation Lisbeth Votruba, MSN, RN. The topic was Preventing Self-Harm, Remotely. Participants included hospital staff from, The University of Kansas Health System, Spectrum Health and Helen DeVos Children’s Hospital.

A Q&A discussion prompted the experts on how using the TeleSitter keeps patients with suicide ideation and other behavioral health patients safe from self-harm via the ability to remotely monitor them 24/7. All care networks that utilize continuous remote safey monitoring to supervise patients who could harm themselves are handled on a case-by-case basis. For example, an inpatient that is a low to moderate risk of self-harm might be a great fit for a TeleSitter, while high risk patients would be better suited for a 1:1 sitter that is always present in the hospital room. AvaSure consistently works alongside its customers to train monitoring staff and management departments to appropriately prepare the caregivers to make these decisions.

Panel representatives also discussed the topic of suicide from a general perspective, reiterating the need to continue normalizing discussions surrounding behavioral health. It’s important to understand the stigmas surrounding suicide so health care organizations and their providers can continue to educate and improve the notions of silence.

The discussion wrapped with timely comments regarding the recent Centers for Disease Control and Prevention (CDC)-issued warning and predictions on the potential increase on the horizon for behavioral health issues, considering the difficult year 2020 has been. The hospital representatives expressed they are starting to see suicidal patients increase, especially in younger adults who are autistic.

Panel 6 – Making Sure the Kids are All Right
A new panel at this year’s symposium was Making Sure the Kids are All Right, which was moderated by Stacey Overholt, MBA, BSN, RN, AvaSure Clinical Director. Panel experts included staff from Anne Arundel Hospital and Methodist Children’s Hospital San Antonio. The participants outlined the benefits and challenges of utilizing continuous remote safety monitoring for those in pediatric care.

Anne Arundel Hospital staff stated they have utilized AvaSure’s TeleSitter platform for more than 8,400 monitoring hours over the past year just in the pediatric department location, which also resulted in an operational cost savings of $200,000 in that sector alone for that time period. Not only does the hospital network see the cost reduction benefit, but they said it allows them to better care for their young patients who are struggling with behavioral health while undergoing inpatient care.

A specific topic that was discussed extensively during the session was the importance of communication between the care staff who are utilizing remote monitoring methods in a pediatric hospital room with the patient’s parent or guardian. We learned that communicating from the beginning on why the patient is being monitored, the fact that the cameras aren’t recording the room and the benefits it provides greatly increased the parent’s comfort when having their dependent in the hospital’s care.

Following the conclusion of the second day panels, AvaSure was incredibly excited to honor the 2020 AvaPrize recipients:

Hub & Spoke Award – WakeMed Health & Hospitals
Path-to-Zero Award – The Miriam Hospital
Safety Net Award – Riverside University Health System Medical Center
Superstar Monitor Staff Member – Megan Fitzsimmons, Oregon Health & Science University Hospital

Keynote – Dr. Kelly Posner Gerstenhaber
The symposium ended on an extremely honorable note. Dr. Kelly Posner presented the final keynote presentation. Dr. Posner is the Professor of Psychiatry at Columbia University and world-renowned expert on the risk of suicide among patients. She spoke about her work in developing the Colombia Protocol, and the importance of shining a light on suicide as a worldwide public health crisis.

The Columbia Protocol, also known as the Columbia-Suicide Severity Rating Scale (C-SSRS), supports suicide risk assessment through a series of simple, plain-language questions that anyone can ask. The answers help users identify whether someone is at risk for suicide, assess the severity and immediacy of that risk, and gauge the level of support that the person needs. In 2011, the CDC adopted the protocol’s definitions for suicidal behavior and recommended the use of the Columbia Protocol for data collection. In 2012, the Food and Drug Administration declared the Columbia Protocol the standard for measuring suicidal ideation and behavior in clinical trials. Today, the Columbia Protocol is used in clinical trials, public settings, and everyday situations, such as in schools, faith communities, hospitals, and the military, to identify who needs help – saving lives in 45 nations on six continents.

Dr. Posner expressed this protocol works because people care and want to engage. Engagement and asking the right questions can quite literally be medicine for someone who is contemplating self-harm or suicide. Suicide is a shared problem of humanity, but it’s the one preventable cause of death. Everyone across the world has in some way been affected by suicide and when you break down barriers by asking tough questions and paying attention, you save lives.

AvaSure is so appreciative of those who made our third National Symposium on Leading Through Change a success. In case you missed any of the presentations and would like to learn more, a recording of the symposium sessions will be available after the event.

We also encourage you to check out the other resources on our website and social media channels. You can find us on Twitter @AvaPrize and on our Symposium Facebook page www.facebook.com/groups/avasurecommunity.

AvaSure Virtual Symposium Recap – Day 1, September 23

Posted on September 24, 2020 by SuperScoutTrooper - Uncategorized

On September 23, AvaSure kicked off its third National Symposium in a virtual format as a result of COVID-19. These events bring together senior leaders, frontline staff and health policy experts to share best practices and new uses for continuous remote patient care. The symposium theme this year is Leading Through Change, which hospital systems and care networks have especially demonstrated throughout the continued challenges of the pandemic.

Brad Playford, AvaSure’s CEO, opened up the day by providing attendees with the latest news about the company and its role in the future of telehealth – which has been proven to be a critical, now more important than ever, force multiplier for healthcare providers and the patients we serve.

Keynote – Wes Moore
Following the opening remarks, attendees enjoyed an incredibly motivational discussion with first day’s keynote speaker, Wes Moore. Wes is currently the CEO of Robin Hood, one of the largest anti-poverty forces in the nation. As a bestselling author, a combat veteran, and social entrepreneur, his insight set the tone for an inspirational day.

Wes provided listeners with an abundance of experiences and examples on how to be a good leader during a time of change, resonating with the force who has been on the frontline of caring for patients who have COVID-19. Not only have health care systems and workers had to adapt to new environments and processes, they are consistently seeking innovative methods of care to keep everyone safe in today’s and future care applications.

Panel 1 – In Isolation BUT Not Alone
After the keynote presentation from Wes, our first panel of experts took the virtual stage. The panel topic, In Isolation BUT Not Alone, was moderated by Cathy Rick and included panelists from Mount Sinai Morningside, Sinai Health and Moanalua Medical.

This topic specifically covered the viewpoint from the respective hospitals and networks alike who are continuing to care for patients with COVID-19. AvaSure’s telehealth technology and remote monitoring system allows caregivers to isolate patients who have the virus, but also ensure an effective secure way to attend to them without risking potential spread and saving valuable resources like PPE.

Panelists expressed they continue to use AvaSure in COVID-19 settings as some unfortunately are experiencing increased case numbers. For example, when licensed teaching hospital Sinai Health had to prevent students from coming in for hands-on learning due to virus risks, they were still able to participate with AvaSure’s monitoring technology – similar to a live teaching simulation. A representative from Mount Sinai Morningside said their hospital used the audiovisual monitoring technology to allow infected patients to communicate with their families who were unable to visit them.

There continue to be new applications the TeleSitter can be used for, many of which have become an invaluable use during COVID-19.

Panel 2 – Preventing Disruptions
The second panel, Preventing Disruptions, was moderated by AvaSure’s Vice President of Clinical Quality & Innovation Lisbeth Votruba MSN, RN, and included participants from Elliot Health System and Piedmont Athens Regional Medical Center. These healthcare leaders discussed the oftentimes overlooked but incredibly important topic of keeping health care workers safe and preventing workplace violence. Special guest Adrien Bardes, Manager of Public Safety, Piedmont Athens Regional also sat in on the panel to provide his expertise.

The experts walked through examples of remote interventions and the application of AvaSure’s telehealth system in keeping staff, patients, and families safe amid the continuing epidemic of illicit substance abuse and issues in behavioral health settings.

Audiovisual monitoring allows hospital staff to continuously monitor patients who might be suicidal, are experiencing drug and alcohol withdraws, could be at-risk of following and much more. This option keeps the patient in a secure and safe environment, alongside protecting the caregivers who interact with them.

Panel 3 – Tales from the Frontline
The final panel on symposium day one was brought back by popular demand! Moderator Pat Quigley, PhD spoke with the hands-on TeleSitter users at systems including Covenant Health, Providence St. Joseph Orange and Abington Hospital Jefferson Health.

The monitor staff revealed best practices, lessons learned and views from behind the camera on time spent watching at-risk patients. If there was one theme consistently expressed throughout this discussion, it was that the day-to-day application of the unique telehealth resource has proven to be a force multiplier in health care – both for patients, staff and their families.

Aside for COVID-19, the TeleSitter allows hospital staff to better connect with their patients and provide a safe and meaningful experience.

AvaSure sends a sincere thank you to our keynote, moderators, panelists and all participants who made the first day of our virtual symposium a success. In case you missed any of the presentations and would like to learn more, a recording of the symposium sessions will be available after the event.

We encourage you to join us today, September 24 from 11 a.m. to 3:30 p.m. EST, as we continue the meaningful presentations and discussions on Leading Through Change. We will hear from experts on best practices is utilizing AvaSure’s technology, how the TeleSitter is used to keep suicidal patients and their caregivers safe, benefits of using our applications in pediatric care units, wrapped up with a presentation from keynote Dr. Kelly Posner Gerstenhaber. AvaSure is also looking forward to honoring the 2020 AvaPrize recipients on day two. Participants can follow along and engage with us on Twitter @AvaSure or our Symposium Facebook page www.facebook.com/groups/avasurecommunity.

Happy Nurses Week

Posted on May 6, 2020 by SuperScoutTrooper - Uncategorized

Our salute to two RNs and those they have chosen to assist

Today is National Nurses Day, which typically kicks off a weeklong celebration, culminating with the anniversary of Florence Nightingale’s birthday. This year, the American Nurses Association extended the event into a into a month-long celebration to “expand opportunities to elevate and celebrate nursing.” Little did they know how appropriate and deserving such a move would prove to be.

Two of our own – AvaSure Board Member Cathy Rick and Clinical Program Specialist Sarah Quiring – have rejoined the ranks of nurses after years away from direct patient care to do whatever is needed.

AvaTalk caught up with them to talk about how their mission to contribute is going.

AvaTalk: When did you decide to actually return to active duty nursing and what was it about the pandemic that drove you to do this?

Rick: I had no plans to go back to work after retiring as CNO of the Veterans Health Administration in 2014. I have enjoyed being engaged in mentoring roles and periodic consulting work for healthcare organizations in addition to my commitment as an AvaSure board member. But then came COVID-19. I know full well how challenging it is to deal with day-to-day operations across a large system like the VHA while, at the same time, fulfilling the needs during a national crisis. So in early April I reached out to longtime colleagues at the VA just to say that I was thinking of them. I offered my support in any way that they thought appropriate, and lo and behold, they immediately took me up on it.

Quiring: Early on in my career as a nurse, I was given a thank-you card by a patient that in paraphrase said: “You were called to this place, at this time, for a purpose.” I have often reflected on that sentiment. By going back to the hospital during the COVID-19 pandemic, I have joined multitudes of others who were willing to show up with their skills when they were needed, whether that was suddenly home schooling their children, providing janitorial services or making masks.

AvaTalk: What is your assignment?

Rick: I was asked what I’d like to do, and said I’ll do whatever you want. I started my virtual assignment to assist with national nurse staffing strategies on April 9th.

Quiring: I am currently working as a staff RN, in an eICU, providing coaching to regional nurses who may have limited critical care experience.

AvaTalk: So what is the nature of the work and how much time is involved?

Rick: I am assigned to support an Office of Nursing Services Workgroup to offer my expertise as a former VHA senior executive. This workgroup has been charged to develop innovative options for meeting staffing needs during surge capacity requirements in this (and future) national emergencies. It’s been a daily whirlwind, working 8-11 hours a day, seven days per week, including Easter Sunday, quite an adjustment from retirement!

Quiring: I currently work full time on the weekdays as a Clinical Program Specialist for AvaSure and work between one and two 12-hour shifts on the weekend in the eICU. I am very fortunate that AvaSure and my local hospital have been both flexible and supportive with this unique arrangement.

AvaTalk: How long do plan on contributing?

Rick: As long as I’m needed. Although the work hours are intense at this time, I would anticipate that will change to a slower pace as newly designed innovative approaches become standard operating procedures.

Quiring: I plan on contributing through the projected census surge time until the hospital resumes serving at typical capacity.

AvaTalk: How does it feel to contribute again on the frontlines?

Rick: It is an honor and a privilege. I am reminded again and again of how nurses are the backbone of global healthcare. It is a very special feeling to be a VA nurse again. My colleagues there are talented, dedicated, forward-thinking federal employees, and the VHA nursing workforce is among the best of that workforce.

Quiring: As a bedside nurse, you have the unique and humbling position to walk alongside people during some of the most difficult times of their lives. This pandemic has taught us that we are all connected, perhaps more than many of us realized. I have the rare opportunity to directly help patients in dire need while also working for AvaSure, whose business is making the jobs of the same frontline staff easier and more productive.

Remote Safety Monitoring: Calling a Halt to Violence Against Health Workers

Posted on April 18, 2020 by SuperScoutTrooper - Uncategorized

Male nurse walking down the hallway of a hospital

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.

AvaSure Gets Double Duty as Support for Staff, Patients, and Families During Pandemic

Posted on April 17, 2020 by SuperScoutTrooper - Uncategorized

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.

Tracking Violence Against Hospital Staff

Posted on July 31, 2019 by SuperScoutTrooper - Uncategorized

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

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