August 31, 2015
5 Benefits to Using Wearable Patient Monitors: Fostering Mobility in Elderly Patients to Prevent Pressure Ulcers and Improve Health Care
Written by Special Guest Blogger Patrick Reinhard, Chief Nursing Officer, Desert Valley Hospital
Pressure ulcers continue to be a common health problem, particularly among the physically limited or bedridden elderly patients. This health and safety issue persists, notwithstanding the imposition of recent Medicare penalties for hospital-acquired conditions like pressure ulcers. A recent study published the Journal of the American Geriatrics Society found that the 2008 Hospital-Acquired Conditions Initiative (HACI) has had little financial impact on pressure ulcer payment changes on Medicare, other payers, and hospitals.
As a nation, we spend more on pressure ulcer prevention and treatment a year than influenza. The cost of pressure ulcers to our health system is more than $11 billion with one in 30 hospitalized patients getting a pressure ulcer during their stay. Yet despite all the resources and innovation applied to pressure ulcer prevention and treatments, compliance to patient turn protocols is shown in the literature to be only between 30 to 66 percent.
To effectively reduce pressure ulcers, we need to focus on simple, cost-effective interventions that improve health outcomes. Manual patient turning is one of the oldest interventions for pressure ulcer prevention and remains highly effective for obtaining desired results.
Desert Valley Medical Center (DVMC), a 148-bed community hospital that serves higher risk populations including elderly and bariatric patients, has significantly improved turn compliance rates.
How did we do this? We started placing wearable monitors on our patients. The wearable patient monitors used by DVMC were developed by Leaf Healthcare, Inc. The Leaf monitor is comprised of a small, lightweight, wearable sensor that electronically monitors a patient's position and movements. Data collected by the sensor is communicated wirelessly to central monitoring stations or mobile devices so that caregivers can check on a patient’s position and movement. The system provides alerts when necessary to ensure that all patients wearing a Leaf monitor are repositioned according to their prescribed turning schedules to reduce incidence of pressure ulcers.
Our experience with wearable patient monitors has shown us four key benefits to their use:
1. Improved Turned Compliance Rates
Frequent repositioning and progressive mobility have been shown to provide significant benefits to hospitalized patients. Recently released guidelines from the National Pressure Ulcer Advisory Panel (NPUAP) recommend repositioning all patients at risk of pressure ulcers, unless medically contraindicated. Using Leaf’s wearable patient monitors, we now know when a patient has been turned and how that patient has been turned.
2. More Effective Offloading
Mere repositioning of the patient does not reduce pressure ulcers. This repositioning must be effective. When we started using the Leaf patient monitors, we found out that we did not have all the necessary wedges needed to keep patients optimally turned. The wearable monitors help us to evaluate patient needs and to assess the availability of equipment and other resources.
3. More Efficient Patient Care
One of the advantages Desert Valley Hospital has realized from the Leaf patient monitors is the value of the reports and the ability to focus on specific areas that can improve the efficiency of patient care. Using data from the patient monitors, our directors have been able to identify areas of care that need better attention or improved re-education of staff.
4. Monitoring At-Risk Patients
Emergency departments do not typically hold admitted patients for long periods of time. However, with the increased numbers of insured patients since the Affordable Care Act took effect, visits to DVMC’s emergency department have increased from about 35,000 visits four years ago to more than 43,000 last year. By monitoring at-risk patients in the emergency department, we may be able to prevent the development of pressure ulcers and ensure continuity of care once these patients are transferred to other units within DVMC.
5. Better Documentation
In reviewing patient charts with the data from the patient monitors, we have been able to determine when we have not had complete documentation. This may have occurred when the patient was off the unit or was undergoing a procedure.
Our experience has shown the value of wearable patient monitors to improve patient care and health outcomes.
Is there value beyond pressure ulcer reduction?
We have recently started using Leaf patient monitors in our labor and delivery unit. Studies show that labor is shortened and the risk of caesarean birth is reduced in mothers who are upright and mobile during labor. However, most mothers in labor are given epidurals and tend to lie in their labor room beds.
As part of our system-wide effort to reduce caesarian sections, DVMC deployed the Leaf wearable patient monitors to be used on mothers who have received epidurals so they can be repositioned every 45 minutes to counter the effects of epidural anesthesia. Nurses get turn alerts on the Leaf system when the bed-ridden mothers have been in the same position for 45 minutes. Nurses are also able to see on the Leaf monitor when mothers are sitting upright, a position that's encouraged.
We hope that turning women who are in labor and on epidurals will speed their labor and reduce the need for c-sections and that the use of Leaf wireless monitoring technology will reduce the length and discomfort of labor and provide expectant mothers with a much easier birth experience.
At DVMC, we continue to evaluate and improve on the care that we provide patients. Using wearable patient monitors is just one instance of this commitment.
Patrick Reinhard, RN, MHA is currently the Chief Nursing Officer at a Prime Inc. facility. Patrick has worked as a nurse for 32 years and filled multiple leadership roles. He will speak at EWTS '15, sharing insight on how to choose the right wearable device for the job. Learn more about him here.