One of the most important areas of patient care is a comprehensive, frequent, and accurate assessment of patient vital signs. However, this is often overlooked with current staff shortages, aging nursing staff, and increased burnout among medical professionals. Unrecognized changes in vital signs can result in preventable deaths in hospitalized patients. Few publications or studies instituting routine patient monitoring have described the implementation and the setting of alarm parameters for vital signs.
Historically, several studies have demonstrated the benefits of continuous monitoring on general care floors as evidenced by the identification of patient deterioration or a reduction in Rapid Response Team calls. One major concern is having a high frequency of alarms, causing desensitization and alarm fatigue for the bedside staff. One approach to address this concern is to reduce the number of alarms that self-resolve without any nursing intervention, otherwise known as non-actionable alarms.
With this being said, there are ways to reduce the number of non-actionable (do not require nursing intervention) alarms on general care floors. Evaluating combination thresholds annunciation delays (“a delay between when an alarm threshold has been crossed and when the monitor and network alert is sounded or displayed”) with the desired outcome being an increased number of alarms per patient per day that may still be considered unacceptable in determining alarm limits.
A prospective, observational, 5-month pilot study conducted by Weller et al. in a 26-bed adult neurological/ neurosurgical unit (non-ICU) at Wake Forest used the ViSi Mobile to assess the impact of continual, multi-parameter VS monitoring on alarm rates, rapid response team (RRT) calls, intensive care unit (ICU) transfers, and unplanned deaths before and during the pilot study.
Adjustments in both the parameters and the delays were made during the pilot study to optimize the number of alarms the staff was receiving without compromising patient safety. Associated with those modifications was a resultant decrease in alarms/patient/day from 11.41 to 2.01
The setting of <=85% SpO2 for >90 seconds resulted in an acceptable alarm rate while maintaining the nurses' ability to rescue patients experiencing episodes of postoperative hypoxemia.
The average alarm rate for all alarms (SpO2, HR, RR, cNIBP) was 2.3 alarms/patient/day, which was a reduction in non-actionable alarms, and enabled effective vital signs surveillance while minimizing the overall alarm burden. The RRT call rate was significantly reduced (p,0.05) from 189 to 158 per 1000 discharges. ICU transfer per 1000 discharges was insignificantly reduced from 53 to 40 compared to the previous 5-month period in the same unit.
Although there is no established universal APD target for hospitalized patients, clinical managers and nursing staff expressed 2 APDs as a manageable but safe goal, having evaluated four iterations of alarm settings during the pilot study before arriving at the final alarm settings.
The constant surveillance monitoring that the ViSi Mobile provides improves clinician workflow and reduces the number of unmonitored patients inside and outside of emergency departments. It is a s a platform for comprehensive vital signs monitoring that keeps clinicians connected to their patients, whether in bed, transport, or ambulating. Featuring comfortable body-worn sensors that allow for freedom of movement, the system enables accurate, continuous monitoring of all core vital signs with beat-to-beat, noninvasive blood pressure, as well as patient activity and posture. ViSi Mobile is a system designed to enhance patient safety, allowing early detection of patient deterioration and connecting clinicians with their patients anywhere.
The ViSi Mobile Monitor can coexist with various medical and enterprise devices based on our lab and live testing. Our co-existence testing involved over 20 different yet common medical devices from differing manufacturers. The ViSi Mobile System can integrate with most EMR systems through HL7 or middleware like Capsule. Active integrations include Epic, Cerner, Meditech, and HMS/Medhost.
Source:
Weller RS, Foard KL, Harwood TN. Evaluation of a wireless, portable, wearable multi-parameter vital signs monitor in hospitalized neurological and neurosurgical patients. J Clin Monit Comput. 2018 Oct;32(5):945-951. doi: 10.1007/s10877-017-0085-0. Epub 2017 Dec 6. PMID: 29214598.