Topic: Isolation Precautions

The impact of COVID-19 on patient safety attendant use

The Impact of COVID-19 on Patient Safety Attendant Use

Shields, L., Lawson, T., et al. (2021). Nursing 2021, 15(10), 42-28

Patient safety attendants (PSAs) provide constant direct observation to patients who have cognitive impairments or thoughts. Some estimates report that an acute care hospital in the United States may spend more than $1 million annually on PSAs, an expenditure often not reimbursed. With no national defined standards to regulate or monitor PSA use, this study sought to determine the impact of COVID-19 on a PSA reduction program in a large Midwestern healthcare system.

Remote Visual Monitoring During a Pandemic

Remote Visual Monitoring During a Pandemic
Keeling E, Cadjoe J, Hawksworth L, Drake J, Davis T. J Nurs Meas. 2020;28(3):437-438.

Challenge

Remote visual monitoring (RVM) is an evolving technology that is caught between cost-versus-benefit and competing priorities in today’s healthcare space Before the COVID-19 pandemic, resistance to RVM in the Inova Alexandria Hospital was high and the reasons why were attributed to:

  • Lack of knowledge
  • Fear of the new technology
  • Lack of motivation to learn about the technology

Solution

The benefits of RVM became clear during the COVID-19 pandemic
Although RVM cameras were used to monitor patients with at-risk safety behavior, which is their normal use, they were also used in more creative clinical ways.

RVM became a much-needed extra set of eyes and ears for the staff at Inova
RVM cameras were quickly scaled up to be used in several ways:

  • To increase the number of critical care patients who could be monitored at one time
  • To help physicians consult with nurses who are in the room of a COVID-19–positive patient
  • To decrease nursing staff exposure to COVID-19

With COVID-19, Inova deployed their cameras 100% of the time
Flexibility, ease of deployment, and ease of use were fundamental to the scalability, as well as to the overall usefulness of this technology.

Perhaps one of the most meaningful uses of RVM was also the most unexpected and most personal: A safety attendant took it upon themself to hum a hymn the patient’s daughter would sing when she visited. This patient was at the end of life and unaware of the restrictions brought on by the pandemic. This beautiful scene was made possible by RVM technology that was used in a way that no one could have imagined.

RVM, although relatively new to the patient safety tool kit, allowed Invova to maintain continuous observation of patients who might exhibit at-risk behavior while keeping the nurses protected from COVID-19 exposure. If there was anything good to have come out of the pandemic, it’s that technologies can be repurposed when an unexpected crisis requires scalable, flexible, innovative solutions.

Disrupting the Nursing Shortage: Meet the “Virtual Nurse”

A few years ago, it was estimated that by 2030 the U.S. would experience a shortfall of more than half a million nurses, with a huge loss in quality and availability of care.

The pandemic sped up the timeline.

The greatest concern was the potential loss of specialized expertise; two-thirds of 6,000 critical care nurses surveyed in August 2021 said they were considering leaving the field from burnout.

Solutions have been hard to find, but Houston’s Memorial Hermann Health System has tried something new:

  • As the COVID-19 delta variant spread, critical care nurses were detailed to an existing central video monitoring facility. There, these “virtual nurses” can care for COVID-19 patients across the system, supporting less experienced bedside nurses and improving patient quality and safety.

Key learning objectives of this on-demand webinar:

  • Discover the basics of virtual care, including the technology and the art of video and audio interactions with patients and bedside staff
  • Learn about policies and workflows Memorial Hermann established for virtual nursing
  • Find out how virtual nurses can make the highest use of specialized care resources

Presenters:

  • Scott Shaver, MSN, LP, RN, CPHIMS, Director of Hospital Information Systems, Memorial Hermann
  • Mary Ellen Carrillo, MSN, MBA, RN, CVRN, FABC, Chief Nursing Officer, Vice President of Nursing, Memorial Hermann
  • Jennifer McGuire, Manager, Staffing, Memorial Hermann
  • Lisbeth Votruba, MSN, RN, Chief Clinical Innovation Officer, AvaSure

Registered Nurses, Patient-Engaged Video Surveillance, and COVID-19

Registered Nurses, Patient-Engaged Video Surveillance, and COVID-19 Patient Outcomes Quigley PA, Votruba LJ, Kaminski JM. Medsurg Nurs. 2021;30(2):89-96.

Challenge

COVID-19 placed more stress on an already stressed nursing staff
During the peak of COVID-19, nurses had to gown-, glove-, and mask-up before entering a patient’s room to provide needed care. However, as total positive COVID-19 cases climbed, patients’ morbidity and mor­tality escalated, and workforce demands for personal protective equipment (PPE) and high-acuity staffing exponentially increased, leaders at every admitting hospital quickly realized the impact on an already stressed nursing workforce.

This was when many turned to patient-engaged video surveillance (PEVS) for continuous patient observation in hospitals. PEVS is an interactive form of video surveillance whereby trained staff can monitor multiple patients simultaneously.

In order to gain insight into medical-surgical nurses’ use of PEVS to meet care demands of high-acuity patients, Quigley, et al, set out to answer the following 4 questions:

  • What are the enrollment and duration of monitoring trends of PEVS into patient care for COVID-19 across hospitals?
  • What is the relationship among patient gender identity, age, and duration of PEVS?
  • How is patient engagement (ver­bal interventions, alarm rate, timeliness of alarm response) different for patients with COVID-19 compared to patients without COVID-19 patients on PEVS?
  • What are the frequencies and types of adverse events experi­enced by patients with COVID-19?

What the Answers Revealed

  • This study included a national sample of 97 partici­pating hospitals throughout the US
  • Over 2 months, 1625 patients with COVID-19 were monitored for 98,918 hours (4121.58 days)
    • Admissions due to COVID-19 accelerated the need for monitoring, peaking on April 9, 2020, with 72 patients added in a single day
    • Over time, admissions decreased, but with no fewer than 19 patients added each day
  • Of total monitored patients:
    • 52% (n=852) were male and 48% female (n=773)
    • Length of stay (LOS) of monitoring was 67.8 hours for males and 63.5 hours for females
  • Most participating hospitals had implemented PEVS before the pan­demic for patient safety, with safety attendants continuously monitoring patients at risk of adverse events, such as falls, sui­cide, elopement, or safety of medical devices

Nurses quickly expanded their ability to observe, interact with, and engage patients, confirming the value of remote patient monitoring

  • Registered nurses nationally admitted 4.8% of patients (n=1625/32,130) to PEVS due to COVID-19, totaling 98,918 hours—about 4121.58 days—of observation
  • Safety attendants verbally engaged with COVID-19 patients on average 17 times in 24 hours, which is higher than in patients without COVID-19 (10.6 times in 24 hours). This may suggest that ver­bal interventions were effective and that activating nursing staff was not needed
  • Fewer alarms were activated—1 alarm/patient-day for COVID-19 vs 1.8 alarms/patient-day for non–COVID-19

It should be noted that the average timeliness of alarm response to the COVID-19 patients was 35.4 seconds, which is 16.4 seconds longer than for patients who were not in isolation. This time difference can be attributed to the time it took staff to apply personal protective equipment before entering the patient room.

Remote safety monitoring provides workflow efficiencies because 1 safety attendant can watch up to 16 patients simultaneously instead of the traditional practice of 1:1 sitters

Solutions that address the nursing shortage—like remote patient monitoring— should be used to transform care delivery and enhance workflow, satisfaction, and confidence, while assuring patient safety, confidentiality, and privacy.

Conclusions

With the COVID-19 pandemic, remote safety monitoring enabled nursing staff to quickly expand their ability to observe, interact with, and engage with patients. The impact of monitoring further confirms the value of investing in proven tech­nology at the point of care. As such, the safety net provided by the integra­tion of remote safety monitoring must be expanded. As experts and leaders in patient care management, nurses deserve hospi­tal administrators who invest in proven technology that is value-added and effective.