Outcomes of Patient Engaged Video Surveillance on Falls ...

Outcomes of Patient Engaged Video Surveillance on Falls ...

Outcomes of Patient Engaged Video Surveillance on Falls, Other Adverse Events, and Workforce Safety Patricia Quigley, PhD, APRN, CRRN, FAAN,FAANP, Nurse Consultant OBJECTIVES + Apply the rapid success of this technology after learning about the results of implementation; + Assimilate the importance of these associations across clinical settings of care and populations; and, + Understand sustainability and spread of this patient safety

program across a wide variety of patient safety needs and result in patient and staff safety. CONFIDENTIAL & PROPRIETARY 2 WHAT WE KNOW + Healthcare Organizations are frustrating slow to integrate technology at the point of care + Harm in hospitals is still and epidemic in healthcare + Technology innovation is exciting

+ Patient Engagement Improves Patient Health Outcomes CONFIDENTIAL & PROPRIETARY 3 PATIENT HARM Remember the news? + IOM: To Err Is Human, Shaping the Future of Healthcare (1999) + 48,000 perhaps as much as 95,000 die each year in hospitals as a result of medical errors that could be prevent

DR. J. JAMES 2013 UPDATE + Provided updated estimate of patient harm + Examined studies 2008 2011 + MDs had to concur on final adverse events then classify the severity of harm + True number of premature deaths associated with preventable harm estimated at more than 400,000/year + Serious harm 10-20 fold more common than lethal harm + Patient Safety America, Houston, TX. A new, evidencebased estimate of patient harms associated with Hospital Care (2013). Journal Pt Safety, 9: 122-128.

CONCLUSIONS + + + + + Epidemic of patient harm in hospitals must be taken serious if to be curtailed Fully engage patient and their advocates during hospital care Systematically seek the patient voice in identifying harms Transparent accountability for harm Intentional correction of root causes of harm

HELP! IVE FALLEN AND I CANT GET UP! 7 WHERE ARE WE? Change in HACs, 2011-2015 (Total = 3,097,400) National Scorecard Estimates from Medicare Patient Safety Monitoring System, National Healthcare Safety Network Healthcare Cost and Utilization Project. WHAT ARE WE DOING? WHY? + Risk Screening vs. Assessment

+ Protect Patients from Injury + Implement Surveillance / Detection Methods + Redesign use of: Over reliance on screening tools Differential Diagnosis + Individualized Care Planning + Identify fallers from non-fallers + Identify those with injury hx or

at risk for injury + Bed Alarms Sitters Intentional / Purposeful Rounding 9 TECHNOLOGY MOBILE UNIT

PORTABLE WALL UNIT PERMANENT CEILING UNIT (DRY WALL) CONFIDENTIAL & PROPRIETARY 10 (CEILING TILE)

TECHNOLOGY SERVER AND MONITORING STATION CONFIDENTIAL & PROPRIETARY 11 EXPANDING THE SAFETY NET: Integration of innovative technology

MONITOR OBSERVER CONFIDENTIAL & PROPRIETARY AVASYS TECHNOLOGY 12 RESPONDER UNIT STAFF

CLINICAL PROGRAM + Support from AvaSures team of RNs + Policies, procedures and protocols + Comprehensive work flow creation + eLearning modules + Onsite clinical education and training + Non disruptive implementation CONFIDENTIAL & PROPRIETARY 13

THE VIDEO MONITOR TECHNICIAN + A new and crucial member of the care team + Importance of their training + Importance of a good hand-off report from the RN + The tools they have to keep patients safe Verbal redirection Call caregiver Stat Alert Alarm CONFIDENTIAL & PROPRIETARY

Jack was the winner of his hospitals Patient Care Technician/Unit Clerk Excellence Award for going above and beyond. 14 CONFIDENTIAL & PROPRIETARY 15

ONLINE REPORTING OF NURSING ANALYTICS + Motivates staff towards results + Informs clinical decision-making + Optimizes operational management of video monitoring program + Begins to provide insight into what causes falls and other adverse events CONFIDENTIAL & PROPRIETARY

16 ENGAGING AND PROTECTING PATIENTS + Monitor Technicians + RN Enrollment + Individualized Care Management + Knowing Patients + Knowing Families + Monitor Technician and Unit Staff Interaction CONFIDENTIAL & PROPRIETARY

17 OUTCOMES + Protecting Those at Most Risk Reduced Falls Reduced Falls with Injury + Elopement from Room + Timeliness of Rescue by Age Group + Rapid Response by Age Group + Reducing Patient Aggression/Violence CONFIDENTIAL & PROPRIETARY

18 NEW RESEARCH: Just Published! Quigley, P., Votruba, L., Kaminski, J. (2019). Outcomes of patient engaged video surveillance on falls and other adverse events. Clinics in Geriatric Medicine. CONFIDENTIAL & PROPRIETARY 19

NEW RESEARCH: Who was protected and how? Quigley, P.A., Votruba, L.J., & Kaminski (2019) Outcomes of patient engaged video surveillance on falls and other adverse events. Clinics in Geriatric Medicine. CONFIDENTIAL & PROPRIETARY 20 NEW RESEARCH: Falls and other adverse events

Quigley, P.A., Votruba, L.J., & Kaminski (2019) Outcomes of patient engaged video surveillance on falls and other adverse events. Clinics in Geriatric Medicine. CONFIDENTIAL & PROPRIETARY 21 NEW RESEARCH: Discussion points + The oldest and most vulnerable experienced the lowest rate of falls 0.38/1000 patient days + Nurses responded to the oldest patients 3 seconds faster than they responded the younger patients

+ Patients who fell had 5 more verbal interventions per day and 0.83 more alarms per day than the non-falling group (p=.0005 and p=.01 respectively) + Staff response time for those who experienced an unassisted fall was 3.4 seconds slower than the overall average stat alarm response time (p=.07) Quigley, P.A., Votruba, L.J., & Kaminski (2019) Outcomes of patient engaged video surveillance on falls and other adverse events. Clinics in Geriatric Medicine. CONFIDENTIAL & PROPRIETARY 22

NEW RESEARCH: Monitor Tech Impact + The patients who fell had 20.5 verbal interventions per patient day, while 15.7 verbal interventions per patient day occurred on those did not fall (p = .0005) + The falling group also had a higher number of alarms than the non-falling group; 2.38 and 1.55 respectively (p = .01) + Staff response time for those who experienced unassisted falls was slower at 19.2 seconds as compared to the aggregate response time to PEVS alarms of 15.8 seconds (p = .07) CONFIDENTIAL & PROPRIETARY

23 NEW RESEARCH: Sitters back to the bedside: Cost savings + Four hundred and fifty-three annualized FTEs would be required to provide 942,482 hours of surveillance by the traditional one-to-one sitter method + With PEVS provided at a monitoring staff to patient ratio of 1:12, the total number of required FTEs is reduced by 92% to 38 FTEs + Cost savings are contingent on the hourly wages of the one to one sitters and monitoring staff

CONFIDENTIAL & PROPRIETARY 24 CALL TO ACTION 25 TJC SENTINEL EVENT ALERT, ISSUE 59 26

NEW RESEARCH: In press Quigley, P., Votruba, L., Kaminski, J. (2019). Patient engaged video surveillance on nursing workforce safety: patient aggression/violence. American Nurse Today. CONFIDENTIAL & PROPRIETARY 27 ADVERSE ABUSE EVENTS FROM 2018 ABUSE EVENTS REPORTED:

+ 136 abuse events SAMPLE SIZE: + 176 hospitals + 78,748 patients + 204,588 monitored patient days CONFIDENTIAL & PROPRIETARY 100 physical 36 verbal

+ 0.66/1000 monitored patient days 28 CONFIDENTIAL & PROPRIETARY 29 PHYSICAL VERSUS VERBAL ABUSE CONFIDENTIAL & PROPRIETARY

30 CONFIDENTIAL & PROPRIETARY 31 RISK FOR AGGRESSION SCALES SCALE COMMENTS STAMP Staring, Tone of voice, Anxiety,

Mumbling & Pacing Validated tool for use in ED OAS Overt Aggression Scale Reliable tool for inpatient adults and children Brset Violence Checklist Validated for adult inpatient psych

BRACHA Brief Rating of Aggression in Children and Hospitalized Adolescents Validated tool for determining best placement in inpatient psych M55 ABRAT Aggressive Behavior Risk Assessment Tool Combines items from STAMP and M55, for a simple 10 item tool. Validated for med/surg patients

V-RISK-10 CONFIDENTIAL & PROPRIETARY 32 LITERATURE REVIEW: Highlights from 80 Customer Generated Results + 6 peer-reviewed journal articles + 30 quality improvement posters, podium or articles

CONFIDENTIAL & PROPRIETARY 33 CONFIDENTIAL & PROPRIETARY 34 CONFIDENTIAL & PROPRIETARY 35

SUSTAINED OUTCOMES + Shift in Nursing Beliefs: Nursing culture can shift and trust and use new technology to improve patient safety and outcomes + Real-time Surveillance decreases noise, stimulation and alarms, and increases rest and sleep (no bed alarms) + Real-time Surveillance provides better focus for nursing practices as the observers are more fully present + More Falls are prevented within and beyond the bedroom, such as to the day room, the hallway + PEVS increases safety for patients and caregivers

the true safety net exists (no false alarms) CONFIDENTIAL & PROPRIETARY 36 ITS PERSONAL PAT AND HER MOM Getting ready to dance CONFIDENTIAL & PROPRIETARY

37

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