Preventing Patient Falls Overnight Using Video Monitoring: A Clinical Evaluation

Remote telemonitoring is associated with improved patient safety and decreased workload of nurses

Objective

There is significant interest in exploring new technologies to improve efficiency and work-life quality for nurses. We aimed to evaluate the impact of a remote video monitoring (RVM) solution that provides continuous in-hospital patient audio-video (AV) monitoring by technicians.

Methods

The RVM system that we developed, consisting of 2-way AV communication and a continuous O2 saturation monitoring device, has been deployed in all inpatient units within our hospital network, including 3 acute care hospitals and 2 rehabilitation facilities. Data were collected before and after implementation on safety measures including fall rates and adverse events, along with device utilization and number of escalation events requiring nursing intervention. Nurse job satisfaction was assessed with surveys.

Results

Data were collected from April 2020 to May 2022. A total of 2087 patients were monitored at 5 hospital sites. The technicians identified 54,716 safety concerns that required them to intervene remotely and address with the patient. Of these, 46,289 required escalation of nursing staff, who were called to the bedside through the RVM alerting technology. Importantly, 8427 safety concerns were managed solely by the technicians without the need for nursing intervention, resulting in 8427 avoided nursing visits to the bedside. The surveyed nurses reported that the RVM technology provided reassurance that additional support was available to assist them in managing their patients. Patients and their families also expressed high degree of satisfaction. Since implementation, the rates of falls and other adverse events have been reduced, with the greatest impact in patients on high-flow oxygen. Code blue and mortality rates decreased from 7% to 1%.

Conclusions

The use of RVM has proven to be a successful innovation at our hospital and has led to improved patient safety. RVM was able to reduce 8427 individual nurse visits to the bedside, allowing nurses to manage the care of patients more effectively while improving both patient and staff satisfaction.

Physical Restraint Use in Nursing Homes-Regional Variances and Ethical Considerations: A Scoping Review of Empirical Studies

BACKGROUND

Physical restraints are known to violate human rights, yet their use persists in long-term care facilities. This study aimed to explore the prevalence, methods, and interventions related to physical restraint use among the elderly in nursing homes.

METHODS

The method described by Joanna Briggs was followed to conduct a scoping review without a quality assessment of the selected studies. An electronic search was conducted to find eligible empirical articles using MEDLINE, PsycINFO, EMBASE, Web of Science, Scopus, Google Scholar, CINAHL, and grey literature. The database search was performed using EndNote software (version X9, Clarivate Analytics), and the data were imported into Excel for analysis.

RESULTS

The prevalence of physical restraint use was found to be highest in Spain (84.9%) and lowest in the USA (1.9%). The most common device reported was bed rails, with the highest prevalence in Singapore (98%) and the lowest (4.7%) in Germany, followed by chair restraint (57%). The largest number of studies reported the prevention and/or risk of falls to be the main reason for using physical restraints, followed by behavioral problems such as wandering, verbal or physical agitation, and cognitive impairment. Most studies reported guideline- and/or theory-based multicomponent interventions consisting of the training and education of nursing home staff.

CONCLUSIONS

This review provides valuable insights into the use of physical restraints among elderly residents in nursing homes. Despite efforts to minimize their use, physical restraints continue to be employed, particularly with elderly individuals who have cognitive impairments. Patient-related factors such as wandering, agitation, and cognitive impairment were identified as the second most common reasons for using physical restraints in this population. To address this issue, it is crucial to enhance the skills of nursing home staff, especially nurses, in providing safe and ethical care for elderly residents with cognitive and functional impairments, aggressive behaviors, and fall risks.