Mirela Prgomet1, Magnolia Cardona-Morrell2, Margaret Nicholson3, Rebecca Lake1, Janet Long4, Johanna Westbrook1, Jeffrey Braithwaite4, Ken Hillman5. 1. Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Level 6, 75 Talavera Road, Macquarie University, Sydney NSW 2109, Australia. 2. The Simpson Centre for Health Services Research, South Western Sydney Clinical School, Liverpool Hospital, Level 2, Education Building, Corner Elizabeth and Goulburn Streets, Liverpool NSW 2170, Australia. 3. Intensive Care Unit, Liverpool Hospital, Level 2, Clinical Services Building, Corner Elizabeth and Goulburn Streets, Liverpool NSW 2170, Australia. 4. Centre for Health Care Resilience and Implementation Science, Australian Institute of Health Innovation, Level 6, 75 Talavera Road, Macquarie University, Sydney NSW 2109, Australia. 5. The Simpson Centre for Health Services Research, South Western Sydney Clinical School, Liverpool Hospital, Level 2, Education Building, Corner Elizabeth and Goulburn Streets, Liverpool NSW 2170, Australia Intensive Care Unit, Liverpool Hospital, Level 2, Clinical Services Building, Corner Elizabeth and Goulburn Streets, Liverpool NSW 2170, Australia.
Abstract
OBJECTIVE: Early detection of patient deterioration and prevention of adverse events are key challenges to patient safety. This study investigated clinical staff perceptions of current monitoring practices and the planned introduction of continuous monitoring devices on general wards. DESIGN: Multi-method study comprising structured surveys, in-depth interviews and device trial with log book feedback. SETTING: Two general wards in a large urban teaching hospital in Sydney, Australia. PARTICIPANTS: Respiratory and neurosurgery nursing staff and two doctors. RESULTS: Nurses were confident about their abilities to identify patients at risk of deterioration, using a combination of vital signs and visual assessment. There were concerns about the accuracy of current vital signs monitoring equipment and frequency of intermittent observation. Both the nurses and the doctors were enthusiastic about the prospect of continuous monitoring and perceived it would allow earlier identification of patient deterioration; provide reassurance to patients; and support interdisciplinary communication. There were also reservations about continuous monitoring, including potential decrease in bedside nurse-patient interactions; increase in inappropriate escalations of patient care; and discomfort to patients. CONCLUSIONS: While continuous monitoring devices were seen as a potentially positive tool to support the identification of patient deterioration, drawbacks, such as the potential for reduced patient contact, revealed key areas that will require close surveillance following the implementation of devices. Training and improved interdisciplinary communication were identified as key requisites for successful implementation.
OBJECTIVE: Early detection of patient deterioration and prevention of adverse events are key challenges to patient safety. This study investigated clinical staff perceptions of current monitoring practices and the planned introduction of continuous monitoring devices on general wards. DESIGN: Multi-method study comprising structured surveys, in-depth interviews and device trial with log book feedback. SETTING: Two general wards in a large urban teaching hospital in Sydney, Australia. PARTICIPANTS: Respiratory and neurosurgery nursing staff and two doctors. RESULTS: Nurses were confident about their abilities to identify patients at risk of deterioration, using a combination of vital signs and visual assessment. There were concerns about the accuracy of current vital signs monitoring equipment and frequency of intermittent observation. Both the nurses and the doctors were enthusiastic about the prospect of continuous monitoring and perceived it would allow earlier identification of patient deterioration; provide reassurance to patients; and support interdisciplinary communication. There were also reservations about continuous monitoring, including potential decrease in bedside nurse-patient interactions; increase in inappropriate escalations of patient care; and discomfort to patients. CONCLUSIONS: While continuous monitoring devices were seen as a potentially positive tool to support the identification of patient deterioration, drawbacks, such as the potential for reduced patient contact, revealed key areas that will require close surveillance following the implementation of devices. Training and improved interdisciplinary communication were identified as key requisites for successful implementation.
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