At Florida Hospital Tampa, we were recently looking for ways to optimize patient monitoring due to the ever increasing use of telemetry, or required continuous electronic monitoring. Several factors have attributed to the demand for telemetry monitoring: an aging, higher acuity patient population and physician desire for higher nurse-to-patient ratios independent of the need for cardiac monitoring. We were experiencing a high demand for telemetry, but our research showed that less than one-third of all patients on our general care floors who required continuous electronic monitoring had cardiac-related conditions.
Given all the recently published articles regarding the insignificant impact that telemetry has on non-cardiac patient safety, it begs the question: Are we really getting the desired results by monitoring non-cardiac patients with telemetry? Patients on telemetry monitoring for cardiac-related events are on them for very justifiable reasons; however, prescribing telemetry for non-cardiac patients who have other than cardiac risk factors can cause a false feeling of safety.
Cross-functional teams within our hospital have, for some time, been looking for ways to increase throughput and improve patient flow, while at the same time continuing to deliver high-quality care. One of the challenges we realized is that our physicians are often requesting to admit their patients to a telemetry-monitored bed believing that telemetry will lead to prompt recognition and timely intervention for life-threatening changes in patients. However, telemetry monitoring only detects abnormal cardiac rhythms. Telemetry systems do not have any way of detecting worsening trends for parameters such as respiratory rate and have no predictive analysis algorithm to highlight when a deterioration event may be in progress.
Alarm fatigue is a growing problem associated with telemetry monitoring. The more patients there are on telemetry, the more alarms nurses are receiving. A study conducted by Life Sync Corp. found that there were approximately 151.8 alarms per 100 hours of monitoring, and 82.0 (54 percent) of those were false alarms. Alarm fatigue is a highly publicized issue and is cited as the most common contributing factor in alarm related sentinel events. According to the recent Joint Commission Sentinel Event Alert, "The number of alarm signals per patient day can reach several hundred depending on the care unit within the hospital." This can lead nurses to becoming desensitized to alarms with potentially tragic consequences.
For the last five years, the ECRI Institute has ranked alarm hazards as either the number one or number two most critical technology hazard facing healthcare. The ECRI Institute stated in its 2012 "Top 10 Health Technology Hazards" that alarm systems, including telemetry monitors, can be the source of problems, and the "alarms actually contribute to the occurrence of adverse events." Common problems include the inability to distinguish the urgency level of an alarm, where the alarm is coming from, alarm conditions not being relayed to staff via notification/nurse call systems in a timely manner, and failure to correct frequent nuisance alarms.
In the search for patient surveillance monitoring for non-ICU, general care patients — which would enable us to reduce the number of patients on telemetry monitors — we discovered technology existed that enabled us to monitor patients continuously in a non-contact manner, thus dramatically reducing alarm fatigue for our staff.
When making the decision to implement a continuous monitoring system, we were looking for a way to remain contact-free, while still continuously monitoring each patient's heart rate, respiratory rate and motion. We opted to try the EarlySense system primarily for this reason. Within the first 90 days after implementing the technology, our staff reported a 31 percent reduction in telemetry use, an improvement that brought with it many positive financial implications. By using a sensor placed under the bed's mattress, and avoiding the use of leads or cuffs, patients at Florida Hospital Tampa were no longer burdened by cumbersome attachments, even while their vital signs were being monitored continuously.
In addition to the monitoring of the patients heart and respiratory rate, we also were able to monitor patient motion, which was critical to our hospital for two reasons: the prevention of falls and the reduction of pressure ulcers. First, by monitoring motion we were able to have a true falls prevention system. We now know when a patient is about to exit a bed so that staff can respond and prevent potential falls. In fact, we had no falls related to bed exit in the first three months of implementing continuous monitoring technology. Second, and equally important, we reduced pressure ulcer occurrences. If the patient is on turn protocol, an alert can now be sent to the caregiver reminding them to turn the patient if the patient has not already turned him or herself. We have the technology in place to know when a patient has turned and even sends a report daily to the manager showing the number of times turned.
The second problem we were looking to solve were issues with ongoing alarm- nuisance. We adopted a technology that sent alarm feedback to caregivers with the exact alarm condition and location, which addressed several of the most common problems with alarms. Instead of an alarm ringing for any problem, alarms became targeted, customized and therefore actionable. This actionable data helps nurses to identify developing adverse events and intervene in a timely manner. Florida Hospital Tampa has since reduced our alarm rate to very few alarms per nurse per shift.
In order for our hospital to optimize patient monitoring and decrease the use of telemetry outside of cardiac cases, we were pressed to find a tailored technology that was relevant to the monitoring needs of each patient. The quality assurance reports that advanced monitoring systems allow us to receive show the number of alerts sent, types of alerts sent, bed exit and turn stats, response times to alerts and the monitoring alarm parameters set for each patient. We can still use telemetry for cardiac patients at Florida Hospital Tampa in our efforts at making FHT a better hospital, but advancements in continuous monitoring technology have enabled our hospital staff to address the needs of general care patients who need additional monitoring for broader clinical and safety coverage.
Wilma Sterbutzel is the director of medical surgical nursing at Florida Tampa Hospital. Prior to this, she was the director of medical surgical nursing at Florida Hospital Zephyrhills. She is the 2004 recipient of the Excellence in Management Award from Tampa General Hospital.