Nurses routinely see the calamitous effects of patient falls. We see the fear in our patients that they may fall again. We see the distress and frustration that our older patients experience when their independence is in question. Nurses also see the clear gaps in fall prevention systems when costs, staffing, and workloads interfere with fall prevention strategies.
The average fall rate has been reported to be as high as three to five falls per 1,000 patient days, with approximately one million annual falls occurring in US hospitals each year. Despite routine interventions, such as hourly rounding, weight-censored alarms, and patient sitters, falls are still happening. Our institution chose to explore electronic visual monitoring (EVM)—a computerized camera monitoring system—as a fall prevention strategy. Research suggests that the use of EVM has the potential to reduce falls, help nurses continuously observe a larger number of hospitalized patients, increase the efficiency and effectiveness of available nursing support staff, and lower costs and spending associated with unwanted patient falls.
As we introduced EVM to our nursing staff, a surprising number of nurses were unaware of the technology and its potential to improve care delivery and reduce falls within our institution. This article discusses EVM as a viable option for preventing falls.
EVM is a remote electronic monitoring system that provides a real-time visual of patients assessed to be at risk for falls and in need of continuous observation. This innovative technology offers a practical solution that addresses the increased number of patients needing fall prevention observation. EVM systems consist of camera units, a centrally located monitor station with server software, and trained monitor personnel. The stationary cameras are mounted to the ceiling or walls of the patient's room and the mobile cameras are mounted on rolling carts for optimal positioning. Both cameras can pan, tilt, and zoom, and they're equipped with an infrared illuminator for low-light environments, two-way audio for patient communication, privacy modes for personal care, and a stat alert alarm for immediate intervention.
EVM transmits audio and visual data that allow staff members to observe multiple patients simultaneously with minimal staffing requirements. One to two trained monitor staff members can observe up to 12 to 15 patients and audibly intervene to redirect patient behaviors or alert other staff members of immediate patient needs. If the monitor staff members feel that the patient is in imminent danger of falling, the stat alert alarm can be initiated to alert all surrounding personnel for immediate response. EVM involves closed-loop communication between the nurse, monitor staff members, the patient, and the patient's family. Further, the visual monitoring and audio interventions are never recorded or publicly displayed. This ensures that staff member and patient privacy is always maintained.
When nursing assessments determine that a patient is at risk for falls and inclusion criteria are met, the immediate initiation of EVM doesn't require a medical order and can occur without delay (see EVM guidelines). Before initiating EVM, nurses should ensure that:
- inclusion criteria are met
- staff members are notified
- patients and their families are educated about EVM
- bedside report with unique patient details is exchanged
- audio and visual clarity is confirmed.
Implementing an EVM system requires equipment, education, and support. Institutional funds must be allocated for equipment purchasing and network redesigns, if needed. Budget and staffing matrixes need to be created to support the around-the-clock managed monitoring unit that using EVM requires.
Preparatory considerations include clinical policy development with defined inclusion criteria, guidelines for patient initiation and discontinuation, and algorithms for equipment troubleshooting and unplanned system outages. Additionally, staff roles and responsibilities need to be clearly specified.
A well-developed educational rollout is essential for successful implementation and ensures correct system usage while magnifying its fall prevention potential. It's important for nurses, monitor staff, and patients to understand that EVM is designed to help nurses redirect at-risk behaviors or intervene with audible alerts when such redirection fails. Therefore, the educational rollout doesn't only include staff, but patients and family as well. Educating patients about EVM ensures their safety and helps them understand the important role that EVM plays in keeping them safe.
Introductory videos, simulation modules, and hands-on training sessions are effective tools for educating staff on newly implemented monitoring systems. However, monitor staff members will require additional education regarding patient cues and appropriate verbal responses to at-risk behaviors. Once staff education is provided using the already mentioned tools, instructor-led skills validation sessions are vital. Training should be individualized to meet staff member needs. We found that more than half of the nurses required some additional education beyond the videos and simulation.
Successful implementation of EVM systems comes down to the nursing team. Strong communication and hand, eye, and verbal coordination are foundational skills that ensure correct use of the EVM system to its highest potential. Recognition of this and fostering protected time for staff members to develop these skills shows the nursing administration's commitment to and support for successful EVM implementation.
Opening the door to safety
Knowledge of technologic advances in fall prevention may help nurses become influential in preventing this growing problem. EVM can help reduce falls and allows nurses to balance work challenges and focus more on direct care. Visual monitoring may also improve patient, family, and staff satisfaction. Learning about and leading innovative change practices can open the door to safer outcomes.
Agency for Healthcare Research and Quality. Falls. 2019. https://psnet.ahrq.gov/primers/primer/40/falls
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