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Spurred by more recent value-based payment programs, healthcare organizations are collecting data through clinical data analytics to measure, trend, and benchmark adverse events at the unit, hospital and system level, and comparing them – or being compared publicly (like it or not!) – with national benchmarks.

It’s not perfect, but we are doing MUCH better at recording and categorizing harms done to patients, even as our track record of preventing them is mixed.

The “Safety Net” for reducing patient harm and falls 
The measure that is not captured is the patient who almost experienced an adverse event, but that event was prevented because of diligent surveillance, immediate action and rapid staff response. This measure, the prevented adverse event – often referred to as a “near miss” – is the true safety net in organizations.

Only AvaSure’s monitoring and program evaluation has added a level of precision to measure this true patient safety net in organizations. The latest generation AvaSure monitoring software allows these near misses to be captured in real time by the monitor tech. ORNA^® – AvaSure’s Online Reporting of Nursing Analytics, is the database that enables you to report, analyze and improve your performance.

How it works
When a monitor staff observes a patient starting to inch closer to the edge of the bed or views a patient reaching for an item too far away, the monitor staff initiates a call to the nurse, while engaging the patient to let he/she know that a nurse is on the way to assist them. They encourage the patient to stay in bed so as to remain safe.

The monitoring staff enters data into that specific patient’s adverse event reporting system, and documents the fall as an averted situation and notes the interaction.

As a result, the AvaSure data collected enables you to measure:

• The number of patients enrolled in surveillance who almost fell.
• The number of patients enrolled in surveillance for fall prevention. Those who tried to get up without help and the fall was prevented.

Reporting and data metrics you care about
Beyond an overall fall rate, you can collect the following data, trended monthly/quarterly, and annually:

1. Overall fall incidence for all patients being watched by AvaSure monitor staff.
2. Overall fall incidence for those enrolled for fall prevention, as well as the rate for those who did not fall.
3. Number of patients who had a fall prevented because of monitor staff‘s intervention. This is the true safety net – vigilance, action and response!
4. Monitor staff performance: The number of interventions/interactions with patients that resulted in a prevented adverse event.
5. Timeliness of emergency response: The number of seconds for staff to arrive at the patient’s bedside following the monitor tech’s activation of the Stat alarm.

All data elements paint the picture of your organization’s safety net. Importantly, data elements 3, 4 and 5 provide you with valid and reliable data that only AvaSure’s ORNA database can deliver. This is a true measure of vigilance and rapidity of response to urgent or emergent patient safety situations.

To capture the true safety net of early detection and timely workforce response with comparative ease and accuracy is very exciting! For each the “early detection of an at-risk situation,” AvaSure’s ORNA database enables data collection of the risk factor that was mitigated/eliminated because of each detection and near immediate staff response (an average response of 13 seconds).

For those using the new software and ORNA, please share with us your experience with measuring prevented adverse events. For those who are not, I have a simple question: What are you waiting for?

Pat Quigley, PhD, ARNP, CRRN, principal of Nurse Consultant, LLC, AvaSure Board Member

As hospitals evaluate ways to improve patient falls, patient outcomes, advance patient safety and address staffing shortages while minimizing costs, they face a pressing concern: How can they provide 24/7 monitoring for high-risk patients without incurring unsustainable labor costs?

Twenty-three healthcare leaders gathered April 13 for a roundtable discussion sponsored by AvaSure at Becker’s Hospital Review’s 9th Annual Meeting, where Terry Olinger, president of the Hospitals and Clinics Acute Care Group at Great Falls, Mont.-based Benefis Health System, shared how the system used the AvaSys^® TeleSitter video-observation system to improve patient safety and lower staffing costs.

“The thing I was really skeptical about was, will this make a difference? … but the [system] really does work … it’s amazing when you see it in action,” Mr. Olinger said. Benefis has been using AvaSys for about two years, with funding support from its foundation.

The AvaSys room unit is offered in three options: a mobile cart, a portable wall-mounted unit or a permanent ceiling unit.  It lets a single monitor technician keep tabs via video on up to 12 patient rooms from a command center – at Benefis it is in the patient flow center. The monitor tech can use the two-way audio to immediately intervene via two-way audio when a patient is at risk of self-harm, such as a fall. The monitor tech can talk to the patient to verbally redirect them. If the situation is emergent, the tech can activate an alarm and a nurse will know to get there right away. Overall, AvaSys helps improve staffing efficiencies by allowing nursing assistants to stay on the floor instead of watching patients 1:1.

Mr. Olinger outlined how the hospital reduced both staffing costs and patient falls.

When the Joint Commission issues a Sentinel Event Alert, it is taken seriously by accredited organizations, a warning that they need to immediately focus on and devote resources to the problem in question. The alert states that healthcare workers are now four times more likely to be victimized than workers in private industry. This workplace violence results in low staff morale, lawsuits, and higher worker turnover. It is essential that these industries look into ways of reducing this violence, perhaps through the use of automated risk management tools to save time and have planned out solutions, or with regular check-ins with staff.

Whatever the method, violence must stop. All staff needs to feel safe and secure in their work environment, in whatever capacity that is. Not speaking up about violence is understandable, they can be worried in case they are not believed or they just feel like it’s their job and they should ‘put up with it’, but that is not the case. Employees would feel more open to speaking up if they felt like they could talk openly with their managers, team leaders, etc. these figureheads need to have a relationship to colleagues and tell them that their voice matters and that they should always speak up.

Look beyond only hiring security
Organizations must begin to look beyond solutions that only increase security and be ready to act when encountering verbal or physical abuse. The AvaSys TeleSitter Solution is a technology that is already positioned to identify and direct interventions in attacks on staff. Now, with recent advancements in software, AvaSys^® assists in the tracking, reporting, and analyzing of workplace violence to reduce the incidence of these events.

Join Commissions action items for reducing workplace violence
The Joint Commission has provided a list of action items to guide organizations towards transforming their environments into safe and secure places of employment. The AvaSys technology provides a platform that significantly contributes towards the implementation of these action items, as described below.

Reporting workplace violence is the first step in creating preventative measures.
The Joint Commission reports that only 30% of nurses report workplace attacks. AvaSys features an adverse event reporting system with customizable alerts so leadership can be immediately notified when the AvaSys monitor tech observes an event, even if the caregiver does not report it. Specifics of who, when, why, and how can be captured through observation and swift documentation. This is then sent directly to leadership so the incident can be immediately addressed, and appropriate resources deployed.

Only through analysis of data from multiple sources can we identify hazards, trends, and new strategies for making the healthcare workplace safe.
AvaSys allows for on-demand analysis of not only adverse events but also near misses through AvaSure’s ORNA^® Program (Online Reporting of Nursing Analytics). Inputs through the AvaSys software will become meaningful predictive metrics that contribute to the development of better risk assessment tools. By training monitor staff on specifics of reportable elements and details needed, ORNA will become a valuable database to aid in determining risk factors, trends, and areas for improvement.

Update work procedures to keep team members secure. By having the means to call for help we can protect staff, eliminate hazards, and implement safer work practices.
AvaSys has a proven track record of already preventing hundreds of potential assaults through the summoning of help by AvaSys monitor techs when they observe threatening situations. The AvaSys Stat Alert alarm, when activated, summons available assistance into the room within seconds. By implementing AvaSys monitoring, staff will feel more protected knowing there is a second set of eyes that will summon help quickly in the event violence occurs. Trends gleaned through analysis will allow caregivers to identify and initiate AvaSys monitoring on patients who are assessed to be at risk for potential violence.

Organizations with a live AvaSys program can begin these interventions immediately. If the software currently in use does not have adverse event or near miss reporting available, then you are eligible for an upgrade.

Contact AvaSure for more information and request your demo to learn how you can prevent further workplace violence against nurses.

Stacey Overholt RN, BSN, MBA, Vice President of Clinical Services, AvaSure

In addition to the rigorous training that AvaSys Monitor Tech receives prior to their first day on the job, the thousands of hours they will spend watching patients on the screen amount to an education on the full range of patient behavior. Making the most of that education, however, is dependent on the monitor techs previous clinical experience.

Many AMTs are or were clinical nursing assistants. This is an invaluable skill set for this new role. Let’s look at what this means in real practice: A monitor tech will frequently see patients becoming restless. The monitor tech without clinical experience may view the behavior as “just something this patient does from time to time.” 

The monitor tech with a nursing assistant background will be able to go further and identify the cause of the distress. It may signal a need for toileting or something more serious. Maybe the pain medication that the nurse gave 6 hours ago is starting to wear off.

Ability to predict behavior
The monitor tech may not be able to immediately diagnose what’s going on with this patient, but they know what questions to ask. They know how to communicate the patient’s needs to the appropriate clinical staff. This is how an adverse event is prevented. Had the monitor tech not spoken with the patient to ascertain why he or she were restless, the patient may have taken matters into her own hands. This could potentially lead to a fall if the patient would then attempt to get out of bed to use the restroom.

Proper communication
In addition to the ability to predict behaviors, a basic knowledge of medical terminology can be key to communication with the clinical staff. When the nurse calls to give the monitor tech report, they will be providing a reason or reasons why the patient needs monitoring. They also will provide additional items for the monitor tech to watch over. The clinician may say, “They have a PICC line in the left arm, a foley catheter and a G Tube.” What does that mean to an AMT who has never worked in a hospital and has no clinical experience? After receiving report, the AMT then asks, “What is a PICC line,” “What is a foley” and, “Where and what is a G-Tube?” When this conversation happens between the AMT and the clinician, the trust is immediately damaged. Inherently, the clinician will avoid important details in future reports to the AMTs because they think, “Why bother. They don’t know what I’m talking about.”

Build trust
At AvaSure, our customers frequently report scenarios like this. Many times, we hear our customers state that they wished they would have required a CNA background for the monitor tech role. Having the ability to clinically observe, having a good knowledge base of medical terminology, and prior experience in the hospital setting will ultimately set the AMT up for success. This in turn builds strong trust between the clinical staff and the AMT. Both are key to having a strong AvaSys program.

Pam Werra, RN, Director of Clinical Services at AvaSure

This is the moment when AvaSure TeleSitter solution users first begin to really understand the opportunity they have at their fingertips. It’s the giddy excitement that flows from the monitor station and makes its way throughout the hospital: “Hey, this thing is really going to work. This can actually make a difference in keeping our patients safe!”

It takes time and huge effort to get to this moment, time that AvaSure’s project team spends preparing an AvaSure program tailored to the hospital’s or health system’s unique circumstances but incorporating lessons we’ve learned from more than 450 installs across the country. For the hospital user, much of that effort is hidden, and what they experience is well-rehearsed clinical education delivered by a team with unique clinical training and experience.

You will feel something the moment these educators walk through your hospital doors. They bring energy, enthusiasm, commitment and belief in TeleSitter. This isn’t just a job to our trainers; it is a way for them to directly impact patient safety and help fellow clinicians provide the best care they possibly can.

So, it is no wonder that after several days of detailed training, when it is time to begin utilizing the TeleSitter system live, when it is time to support the monitor tech watching the patients, when it is time to show the nurses that this system really works, that first save is always the AvaSure trainer’s Moment of Glory.

Nothing can fully describe it. The culmination of many weeks leads to this moment when the monitor tech speaks to a patient and successfully gets him to stay in bed, or the tech calls a nurse who gets to the room in time to help a patient move from the chair to the bed, or she sets off an alarm and five people show up in the room in a matter of seconds.

It’s the same every time: The situation is controlled, the fall is prevented, and everyone suddenly knows they have a powerful new tool to keep a professional eye on patients 24/7 and a means of instantly communicating when a threat to safety arises.

Of course, much more is to come once staff realizes the many other uses of this system. We are always heartened to hear of AvaSure saving lives in patient holding areas; of elopements avoided; of nurses simply feeling better about being late for rounding while they deal with an emergent patient, knowing someone is watching their at-risk patients.

Those are great moments too, but for us, nothing quite matches the feeling of seeing that first save and what it means for the nurses and techs who care just as much as we do about keeping patients safe.

Stacey Overholt, RN, BSN, MBA, VP of Clinical Services at AvaSure

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.

Transition
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.

Communication
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. 

Stacey Overholt, VP, Client Services, AvaSure

Though the AvaSure TeleSitter solution was developed to address the intractable problem of patient falls, my 50 years of experience as a nurse suggests that this groundbreaking technology has an even broader application. The TeleSitter platform addresses a fundamental paradox in patient care that heretofore has prevented us from developing a true culture of safety.

My first job was on the night shift of a 20-bed surgical ward. With the assistance of one nurse’s aide, I managed the pre- and post-operative care of 20 male patients from 11 p.m. to 7 a.m., five days a week. The beds on the ward were placed along the perimeter of the large room, and were separated only by curtains that were pulled when privacy was required. The nurses’ station was located conspicuously (and conveniently) in the center of the ward. As a young nurse, this was where I felt safest. I had a 360-degree view of the room and all 20 patients, but perhaps even more importantly, they could see me, and were equally reassured.

In those days, when the length of stay was much longer, it was not unusual for ward patients to become acquainted. They often helped each other and frequently brought critical information to my attention that I might not have known otherwise. This community of care was grounded in the shared experience of hospitalization and surgery. Benefiting from continuous observation and communication, it became a naturally occurring culture of safety. Of course, on the downside, was the necessary restriction on visitors and the absence of complete privacy.

Over the years, we have seen hospitals evolve into more hotel-like venues of care.  Wards were replaced by semi-private rooms with en suite bathrooms. Most recently, there has been significant movement to single-bed rooms that accommodate the 24-hour presence of family members. While privacy and visitor flexibility issues were resolved in this new architecture, it has not been without unintended consequences, including the insecurities experienced by anxious patients and families, left unobserved in the unfamiliar environment of a hospital room. Patients admitted to activating the call light just to see if anyone would come and how soon. In addition, the cost of care increased, as more nurses were required to serve patients in this new care topography.

At the same time, advances in biotechnology permitted many more procedures to be performed in outpatient venues and also reduced the length of stay for inpatient procedures. Thus we are left, paradoxically, with patients who are sicker and more needy, in a context where continuous patient observation and communication are more compromised.

Reconciling the desire for privacy with the need for scrutiny has challenged our capacity to create a culture of safety. Though nurses are at the heart of this paradox, our work is poorly understood. Unlike physician work, which is measured and compensated in terms of visits and procedures, nurse work is calculated and compensated in terms of expert presence. There are, of course, many components of nursing practice that are procedural, but vigilance and advocacy – requiring uninterrupted observation and communication – is at its very core. Indeed, the only reason for physicians to admit patients to a hospital these days is the need for expert and continuous 24-hour vigilance, which, ironically, is the most difficult to deliver.

Like firefighters or air traffic controllers, nurses are needed not just for the rescue, but for their preparedness and for averting the need to rescue. When nurses are not able to observe and interact with their sickest or most compromised patients, our professional self-confidence is adversely affected. When an actual incident occurs, our professional self-worth is diminished. Creating a “culture of safety” must extend beyond checklists and performance goals that reward only what doesn’t occur (no pressure sores, no central line infections, no ventilator-associated pneumonias, no falls, no readmissions, etc.). Most of us became nurses to have a positive impact and add value to the lives of our patients, not only to protect them from harm but to promote their well being as well.

I view TeleSitter as my new, 20-bed ward, where our patients have the benefits of 360-degree and continuous observation, but within the privacy of a single-bed environment, where friends and family are free to visit and stay as long as desired. AvaSys is an ingenious and necessary response to the irony of trying to provide affordable vigilance in a context designed for privacy. Nurses, as well as patients, are well served by this technology. They can feel confident that all of their patients are safe even when they are caring for their other patients.

On behalf of nurses everywhere, thank you, AvaSure, for your contribution to the culture of safety.

Melanie Dreher, PhD, RN, is Dean Emeritus, Rush University College of Nursing and Board Chair, Trinity Health System.