Keeping Patients Safe Through Video Monitoring
It's always nice to know that someone is looking out for you. Patients at University Hospital now have one more reason to feel that way, with the introduction of UW Health's Video Monitoring Program.
Developed to free up valued nursing assistants (NAs) from constant observation duties, the Video Monitoring Program is proving to be a cost effective way to enhance patient care and further build trust with patients and their families.
According to Suzanne Purvis, DNP, RN, GCNS-BC, CNS, geriatrics, and part of the Nursing Practice Innovation group, the Video Monitoring Program is designed for patients whose conditions demand an extra level of attention from nursing staff.
"The patients we monitor are typically deemed ‘at risk' because they might try to pull on a line or take off their oxygen because they're confused and don't know what it is," Purvis says. "If they have dementia or delirium they keep forgetting that they've injured their leg and can't stand, and they try to get up and they could fall."
Up until now, such a patient would need a Patient Safety Attendant (PSA), or "sitter," to stay in his or her room and provide constant observation. PSAs are nursing assistants, who can provide care as well as 1:1 observation.
"We don't want to restrain the patient," Purvis explains. "We have a very low restraint rate, and we do want them to be able to get out of bed and walk with assistance, and keep lines intact. A safer way is to have a PSA with the patient in the room, but we would send NAs to fill the PSA roles and eventually be lacking NAs in other areas where they would be needed since they're usually caring for several patients."
But what if that ratio could be reversed, and one NA could provide security for four or five patients without compromising the level of care for any of them? Now it can be done, with the help of a silent, unobtrusive, state-of-the-art video camera that keeps constant watch over the at-risk patient and makes sure that nursing staff are alerted whenever the patient puts him- or herself in danger.
Here's how it works: When a patient needs constant observation and meets certain criteria, he or she can be watched over by a portable video camera on a stand at the end of the bed. The camera can zoom in or out, observe the entire room, switch to night viewing when the patient is asleep, and provide two-way audio. A Video Monitoring Tech, who also happens to be an NA with patient care experience, sits in the monitoring room and watches several patients on a single video monitor. When one of those patients exhibits behavior that could place him- or herself in danger, the monitor can immediately alert the unit that the patient needs help, or speak directly to the patient through the camera before the patient experiences any difficulties.
"Some patients don't need constant observation, but they need an occasional reminder not to pull on the line or get out of bed without assistance," Purvis explains. "Maybe they just need the monitoring for a few days to get over this bad spell, but we need to keep them safe."
For those patients, the Video Monitoring Program provides many benefits.
"Now, one advantage to the camera, especially at night, is that where we used to have an NA sitting there in the dark as the patient sleeps, the camera has infra-red and can zoom in to watch the patient unobtrusively," Purvis explains. "Sometimes patients may forget they're in the hospital. Sometimes they forget how to use the call button. They're going to get up and try to find something. The monitor tech can say, ‘I'm sending someone to your room—they're on the way.' And the patients respond to the tech's voice when they hear it through the camera."
"Another thing we found, that I didn't expect, was that some patients found it more annoying and irritating and upsetting to wake up and have someone sitting there staring at them," Purvis explains. "I was afraid the cameras would upset the patient, but we find that they don't."
Kelly Januchowski, now a nursing staff scheduler, was one of the first VMTs trained for the program when it debuted 15 months ago, and she noticed an immediate effect on patients.
"It was definitely an adjustment; people were very nervous about our ability to ‘prevent disasters' from happening," she says. "But, it's worked very well. Patients who didn't do well with sitters in the room, who would become verbally aggressive, etc., would do really well with the camera, specifically because they can't be verbally aggressive to the camera, because the camera doesn't have a ‘face.'"
"As far as staffing, it has helped us out a lot with getting observation on the patients who need it, so we are able to monitor them and make sure they're ok, because we have more people available," Januchowski says. "By having one NA watching four or five patients, we have four extra NAs who can care for patients and address other duties."
"The camera is also a ‘transitioning tool' for transitioning patients out of constant observation," she explains. "We want our patients to be safe while they are in the hospital, and using the camera is one more step in a patient no longer being under constant observation and being able to go home."
It might seem strange that a video camera can enhance patient care, but as Purvis explains it, the Video Monitoring Program is proving its effectiveness every day. The hospital has recently added three more cameras and will purchase more as the program expands.
"We do everything we can to make sure the care is excellent, and that we don't introduce something that interferes with that," Purvis says. "We want to make the patient/caregiver connection happen more. So, now we have more staff to give care, which is what they're there for."