Topic: Sitter Reduction

Individualized Fall Prevention Program in an Acute Care Setting

Individualized Fall Prevention Program in an Acute Care Setting: An Evidence-Based Practice Improvement
Spano-Szekely L, Winkler A, Waters C, et al. J Nurs Care Qual. 2019;34(2):127-132.

Challenge

A hospital’s fall prevention program was not consistently effective. The baseline fall rate was 3.21—higher than the National Database of Nursing Quality Indicators’ median of 2.91. Before the implementation of this evidence-based fall prevention protocol, the fall prevention program at as 245-bed Magnet- and Planetree-designated community hospital located in the Northeast was inconsistent and not effective.

Solution

Adding video monitoring. A clinical practice guideline with 7 key practices was used to guide the development of an individualized fall prevention program with interventions to address 4 fall risk categories and an algorithm to identify interventions. Interventions included nurse-driven mobility assessment and purposeful hourly rounding.

Video monitoring was also implemented. Using the video monitor, a safety technician was able to see if patients started to get out of bed and then use the intercom to redirect the patient, thus preventing falls. These “good catches” would not have happened without video monitoring.

With full and consistent implementation of the fall prevention program and the addition of video monitoring, this hospital saw:

  • A 54% reduction in falls from 2.51 falls per 1000 patient days to 1.15 falls per 1000 patient days
  • A 72% reduction in sitter usage, equating to $84,000 in annual savings

Video Monitoring for Fall Prevention and Patient Safety: Process Evaluation and Improvement

Video Monitoring for Fall Prevention and Patient Safety: Process Evaluation and Improvement
Sand-Jecklin, K., Johnson, J., Tringhese, A., Daniels, C., & White, F. (2019). J Nurs Care Qual, 34(2), 145-150.

Abstract

Background: Although video monitoring has been shown to reduce falls among at-risk hospitalized patients, there are no identified best practices for the monitoring process.

Purpose: The purpose of this study was to evaluate the monitoring process at a large teaching hospital, with the goal of making improvements and standardizing monitoring practices.

Methods: Patients and nursing staff perceptions about the video monitoring process were elicited via survey, and perceptions of monitor technicians were obtained through structured interview.

Results: Video monitoring was perceived by all groups as effective in promoting patient safety. Nursing staff and monitor technicians also indicated that monitoring protects patient safety in other high-risk situations. Suggestions for improvement and standardization in the monitoring process were made by study participants.

Conclusions: Suggested changes and standardization of the monitoring process have been implemented in the study facility. Insights are provided for other facilities considering video monitoring for patient safety.

Improving Patient Safety Through Video Monitoring

Improving Patient Safety Through Video Monitoring
Cournan M, Fusco-Gessick B, Wright L. Rehabil Nurs. 2018;43(2):111-115.

Challenge

Patients receive mixed messages—try to be as independent as possible, but don’t do anything in your room without calling for assistance. Falls are a significant issue in rehabilitation settings. Patients are encouraged to be as independent as possible, yet not to do anything without assistance. This mixed message leads to the increased risk for falls in this setting.

Solution

Video monitoring significantly lowers the risk of falls. The focus of this project was on a 31-bed brain injury unit of an inpatient rehabilitation facility where the majority of falls occurred. Fifteen video monitoring units were installed and total falls and falls rates were tracked.

With video monitoring:

  • The average number of falls was decreased to 6.87 falls per 1000 patient-days compared with 10.26 falls per 1000 patient-days before video monitoring was implemented. This is a statistically significant improvement
  • There were 32 fewer falls in a 1-year period
  • There was a reduction in costs due to falls and fall-related injuries of at least $40,000 —this sum is thought to be a conservative estimate
  • The hospital saved nearly $190,000 on the cost of 1:1 sitters
  • Total costs for the video monitoring system were recouped in 12 months of continued use

Staff response to the video monitoring system has been strongly favorable.

  • 81% of respondents indicated either a generally or strongly favorable reaction to the video monitors
  • Nearly all respondents—96%—felt that video monitoring did not intrude on privacy

Conclusions

Video monitoring can provide greater safety for patients by decreasing falls. Additionally, video monitoring decreases sitter usage and its cost, and enhances satisfaction.

Effort Continues to Prevent Patient Falls within Phoebe Putney Health System

ALBANY — The Phoebe Putney Memorial Hospital Board of Directors got its first look Wednesday at a new piece of technology meant to help prevent patient falls.

The AvaSys Telesitter® program, which has 12 units between the main hospital and Phoebe North, works by putting more eyes on patients.

Equipped with an infrared camera and two-way audio, it is set up in rooms of patients identified as high risk for falls. One technician can monitor live feeds on the units from those rooms at a central station.

If a patient tries to get out of bed, the observer can interact with the patient with a reminder to wait for assistance or sound an alarm for immediate staff attention. Patients in imminent danger receive an alarm, which signals the staff to head quickly to the patient’s room.

“Within seconds, someone is in the room,” April Little, a central staff manager for Phoebe Putney Health System, said of the alarm.

Read the full article to learn more.

Outcomes of Clinical Nurse Specialist Practice in the Implementation of Video Monitoring at an Academic Medical Center

Outcomes of Clinical Nurse Specialist Practice in the Implementation of Video Monitoring at an Academic Medical Center
Purvis S, Kaun A, McKenna A, Viste JW, Fedorov E. Clin Nurse Spec. 2018;32(2):90-96.

Challenge

Caring for patients with increased safety needs and those needing 1:1 observation is a challenge to hospital resources. One of the most expensive safety practices in acute care hospitals in the United States is the use of constant observation. Most programs are developed with patient safety in mind, but the costs increase over time.

What’s more, the literature on constant observation shows very little proof of improvement in successful outcomes, such as fewer falls.

Solution

Clinical Nurse Specialists identified 8 units for a pilot program using video monitoring. During the 3 quarters following the implementation of video monitoring, there was a significant impact on resource utilization. With the use of full-time patient safety attendants, there was an approximate annual savings of $211,000 and no increase in the number of falls.

TeleSitter® System Keeping Patients Safe

LAKE CHARLES, LA (KPLC) – Patient safety is paramount in hospital settings and traditionally, it has taken one-to-one care 24 hours a day for some of the most at-risk patients.

That can tie up skilled nursing staff from other demands and that is why a new video monitoring system has been launched at Lake Charles Memorial Hospital.

It is called the AvaSys Telesitter® Solution and through a two-way audio system, video camera, and central monitoring station, Memorial nurse manager, Tressy Bergeron, is able to keep an eye and ear on up to 12 patients at one time.

Watch the full story here. 

Remote Video Monitoring: A Novel Approach in Fall Prevention

Remote Video Monitoring: A Novel Approach in Fall Prevention
K Bradley. J Continuing Education in Nursing. 2016;47(11):484- 486.

Challenge

In-hospital safety sitters are associated with a range of disadvantages. Safety monitors are a valuable resource in maintaining patient safety. Yet, there are limitations:

  • They are typically used in hospitals to directly observe 1 to 2 patients to prevent patients from falling or injuring themselves.
  • As a resource, they are not always available to nurs­ing staff due to the difficulty in predicting when they are needed.
  • Their use increases the costs of delivering care.

Hence, this frequently results in ac­quiring per diem staff or reassigning staff to monitor fall risk patients. Such alterations in staffing can lead to job dissatisfaction.

Solution

Remote Video Monitoring with AvaSure. Remote video monitoring provides a live-stream video of patient activity as an additional safety intervention in preventing falls.

This technology provides an innovative fall prevention strategy that allows the sitter to moni­tor multiple patients at one time.

It is important to keep in mind that sitters require training to use the software functions, such as navigating the camera and alert options, and have the confidence needed to verbally intervene when they rec­ognize unsafe patient behaviors. Additionally, the remote sitter must be able to multitask, such as demonstrating competencies using the PC while monitoring the television screen, allowing them to visualize each of the patients being monitored.

While remote video monitoring may not completely end patient falls, it is an additional resource that can be used in the clinical ar­senal of fall interventions—and having an extra set of eyes to monitor patient activity is always helpful.

Conclusions

This technology provides an innovative fall prevention strategy that can improve fall-related patient outcomes and sit­ter costs.

Video Monitoring to Reduce Falls And Patient Companion Costs For Adult Inpatients

Video Monitoring to Reduce Falls and Patient Companion Costs for Adult Inpatients

Votruba, L., Graham, B., et al. (2016). Nurs Econ, 34(4), 185-189

Abstract

With increasing acuity and simultaneous pressures for optimal productivity, reducing unnecessary patient companions has been a focus for many health care organizations. At the same time, nursing leaders are seeking to accelerate improvement in patient safety, specifically the prevention of falls. This study suggests the use of remote video monitoring is a safe tool for fall prevention. While there was a decrease in 1:1 sitter usage, there was no corollary increase in falls. In fact, falls decreased 35%. Not only was video monitoring a safe intervention, it was more effective than patient companions alone in decreasing falls by expanding the number of patients who are directly observed 24/7.