Given the current staffing crisis, many healthcare organizations are reexamining their work environments and looking for ways to improve clinician satisfaction. If hospitals have taxing workflows or fail to adopt the latest technologies, staff may begin looking elsewhere for better job opportunities — and based on the current landscape, they will have no trouble finding them.
Becker’s Hospital Review recently spoke with Gary Warren, president and CEO of ivWatch, about advancements in continuous monitoring technologies and how these tools can improve working conditions for clinical staff members, reduce burnout, enhance efficiency, and improve patient safety.
Continuous patient monitoring systems reduce the frustration and risks associated with alarm fatigue
Technology has evolved since health systems first adopted continuous patient monitoring solutions for pulse oximetry and heart rates. As Mr. Warren explained, “In those days, continuous monitoring devices were simply a sensor connected to an output alarm. If the sensor went out of bounds, the alarm went off. This resulted in huge numbers of false alarms, which nurses frequently had to reset. Needless to say, this created a lot of frustration, as well as alarm fatigue, where staff ignored alarms completely.”
Over the last 20 years, advancements in electronics, like chips and microprocessors, have revolutionized continuous patient monitoring. As a result, it is now possible to monitor many new physiological parameters with greater accuracy and ease. ivWatch, for example, continuously monitors and detects peripheral intravenous (IV) infiltrations or extravasations in a noninvasive way. A small biosensor is placed adjacent to the IV site and a patient monitor notifies clinicians at the earliest signs of a problem due to leakage of IV fluid outside of the vein and into surrounding tissue.
Another benefit of the advancements in continuous patient monitoring technologies is the dramatic reduction in false alarms. “Today, a microprocessor sits between the physical sensor and the output screen,” Mr. Warren said. “The microprocessor runs sophisticated signal processing algorithms which are designed to eliminate as many false alarms as possible. ivWatch has over 60 global patents and more than half of those focus on mitigating false alarms.”
Many first-generation continuous patient monitoring solutions were deployed on patients’ beds, which also contributed to large numbers of false alarms. According to Mr. Warren, “With those systems, every time a patient leaned forward or tried to eat a meal, the bed alarm went off and the nurse had to come into reset it. That had a profound negative effect on clinician workflows.”
To reduce clinicians’ administrative burden and make workflows more patient-centric, ivWatch analyzed patients’ daily activities in the hospital and then designed a system that would provide readings without giving false alarms. “During our clinical studies, we created hospital room simulations and people volunteered to come in for 24 hours and live like a patient,” Mr. Warren said. “We tracked their activities to ensure our technology wouldn’t contribute to alarm fatigue.”
ivWatch reduces the clinical burden associated with monitoring peripheral IV sites and improves patient safety
Peripheral IV catheter insertions are the most common invasive hospital procedure performed worldwide. Yet half of peripheral IVs fail and 23 percent of those failures are due to infiltration. Historically, healthcare organizations have relied solely on periodic, in-person monitoring of peripheral IVs to detect problems. This practice, however, is time-consuming for nurses.
“Conforming to nursing standards of care often translates into heavy workloads for clinical staff,” Mr. Warren noted. “For example, when vesicant drugs are administered via an IV, they can be caustic. As a result, nurses are supposed to check IVs every 15 minutes for infiltrations and extravasations when vesicant drugs are used. That’s very difficult to do as nurse-to-patient ratios decrease. Even lower-risk IVs must be checked at least every four hours.”
Periodic monitoring of IVs is also risky for patients since clinicians don’t always catch IV failures at the earliest stages. Infiltrations and extravasations can result in skin necrosis, amputation, compartment syndrome, nerve damage, scarring, and medication dosing errors.
Not all infiltration or extravasation issues are identifiable at their earliest stages through a cursory examination and conversation with patients. These issues are not always visible until symptoms have already begun, which could lead to now unpreventable injury.
“Continuous monitoring of peripheral IVs is crucial, especially when patients are unable to communicate like in neonatal units and intensive care units where patients may be intubated,” Mr. Warren said. “ivWatch aligns with evidence-based standards of care, and is used in a variety of healthcare environments from daily infusions to the most critical of patients. The solution is with patients 24/7, providing an extra set of eyes to help clinicians reduce patient harm.”
During the pandemic, the benefits of continuous patient monitoring solutions like ivWatch became even more evident. To minimize exposure to COVID-19, conserve PPE and prevent the spread of the virus to other patients, some hospitals placed infusion pumps outside of patient rooms and ran tubes either under room doors or through holes in the wall. Under these conditions, relying solely on limited in-person checks for infiltration and extravasation is even more risky.
A recent journal article described a 72-year-old woman who was hospitalized due to COVID-19 pneumonia superimposed with bacterial pneumonia and sepsis. She was given doxycycline intravenously, which is a vesicant drug, and experienced a severe infiltration injury. This led to compartment syndrome. After emergency surgery and 7 months of follow-up care, the patient’s wound was healed and doctors were able to preserve the patient’s hand function close to 60 of 100 (per patient’s self-assessment) due to scar contracture and limitations of wrist movement.
As nurse-to-patient ratios decrease, less time is available to spend with each patient. Continuous patient monitoring solutions like ivWatch can offer clinicians “breathing room” during unprecedented times like pandemics, as well as extra support during routine patient care. When continuous monitoring solutions and other advanced technologies are used, nurses can perform focused assessments and have more meaningful patient interactions; when they are not in the room, these technologies can provide important real-time notifications. Monitoring solutions, like ivWatch, are valuable tools to give nurses insights into what they cannot always see and help improve patient safety outcomes.
With healthcare staffing shortages, it’s time to give continuous monitoring solutions a second look
Continuous monitoring technologies have come a long way, thanks to advances in microcomputing. By extracting signals from sensors, more types of patient monitoring is now possible. In addition, clinician workflows associated with continuous monitoring are more streamlined, since false alarms have been significantly reduced.
“I think healthcare leaders need to give continuous monitoring a second look, in light of the current staffing shortages,” Mr. Warren said. Like other continuous monitoring solutions, IV monitoring shouldn’t still be stuck in the 80s. Technology has changed and so should the way we monitor for patient IV safety.”