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Remote Video Monitoring: A Novel Approach in Fall Prevention

DOI:10.3928/00220124-20161017-04
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Kenesha Bradley at Ochsner
Kenesha Bradley
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Abstract

Adequate fall prevention interventions are a challenge that nurses continue to endure. Remote video monitoring can be used in conjunction with other fall prevention interventions. This article describes remote video monitoring technology and the benefits and challenges associated with its implementation. J Contin Educ Nurs. 2016;47(11):484–486.
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484 Copyright © SLACK Incorporated
clinical updates
Associate Editors: Elaine L. Smith, EdD, MSN, MBA, RN, NEA-BC, ANEF
Karen L. Rice, DNS, APRN, ACNS-BC, ANP
Author:
Associate Editors: Elaine L. Smith, EdD, MSN, MBA, RN, NEA-BC, ANEF
Karen L. Rice, DNS, APRN, ACNS-BC, ANP
Author: Kenesha Bradley, MSN, APRN, ACNS-BC
Remote Video Monitoring: A Novel Approach in Fall Prevention
Clinical staff are challenged daily
to identify risks and imple-
ment prevention measures to keep
patients from falling. Adequately
mastering and sustaining this skill
has been a challenge in nursing for
decades primarily because fall pre-
vention is complex and involves
individualized multimodal patient
interventions. Often, when all else
fails, nurses turn to one-to-one
safety sitters as an intervention to
prevent falls that can be costly to
health care institutions (Rochefort,
Ward, Ritchie, Girard, & Tamblyn,
2012). Remote video monitoring is
becoming more popular as an alter-
native to safety sitters and is begin-
ning to show its worth in reducing
inpatient falls (Brown & Wollosin,
2013).
CHALLENGES WITH SAFETY
SITTERS
Safety sitters are typically used
in hospitals to directly observe one
to two patients to prevent patients
from falling or injuring themselves.
Safety sitters are a resource that are
often not readily available to nurs-
ing staff due to the difficulty in
predicting when they are needed.
Hence, this frequently results in ac-
quiring per diem staff or removing
a staff member (i.e., unit secretary,
nursing assistant, or nurse) from
their shift assignment to monitor
fall risk patients. Frequent changes
in staffing assignments or removing
ancillary resources to sit can lead to
negative perceptions of job satisfac-
tion.
Safety sitters increase care de-
livery costs associated with staff-
ing and redirect available resources
from patients with less risk to those
at a higher risk. A recent study at a
U.S. institution estimated their an-
nual sitter cost at $3,197,515 across
two hospitals in a system (Burtson
& Vento, 2015). In an effort to find
an alternative to safety sitters, many
institutions are now looking to re-
mote video monitoring to help with
patient safety.
NEW TECHNOLOGY: REMOTE
VIDEO MONITORING
Remote video monitoring lever-
ages the health care facility’s current
wireless system, providing live-
stream video of patient activity as
an adjunctive safety intervention to
prevent falls with injury. The wall-
mounted or mobile video monitor
is placed in the patient’s room for
the telesitter to directly visualize
the patient and facilitate two-way
communication with the patient us-
ing a speaker and microphone. This
video-monitoring technology is
equipped with infrared technology
to help with visualizing the patient
during the night or in the dark, and
360° rotation with zooming capa-
bilities to scan the area and closely
monitor patients’ activities. To pro-
tect patient privacy, the system is
only capable of live video feed and
does not record or store any video.
The AvaSys® system is a popular
video-monitoring technology be-
cause it does not require integration
with the nurse call bell system. Prior
to initiating this type of system, it is
important to collaborate with your
Ms. Bradley is Clinical Nurse Specialist, Ochsner Medical Center Westbank, Gretna, Louisi-
ana.
The institution has a contract with AvaSure and is currently utilizing AvaSys video monitor-
ing system.
The author has disclosed no potential conflicts of interest, financial or otherwise.
Address correspondence to Kenesha Bradley, MSN, APRN, ACNS-BC, Clinical Nurse
Specialist, Ochsner Medical Center Westbank, 2500 Belle Chase Highway, Gretna, LA 70056;
e-mail: kebradley@ochsner.org.
doi:10.3928/00220124-20161017-04
abstract
Adequate fall prevention inter-
ventions are a challenge that nurses
continue to endure. Remote video
monitoring can be used in con-
junction with other fall prevention
interventions. This article describes
remote video monitoring technol-
ogy and the benefits and challenges
associated with its implementation.
J Contin Educ Nurs. 2016;47(11):484-
486.
485
The Journal of Continuing Education in Nursing · Vol 47, No 11, 2016
facility’s information technology
department to ensure that Internet
bandwidth can support the wireless
functions.
TELESITTER ROLE IN VIDEO
MONITORING
The telesitter role has typi-
cally been designated to nursing
assistant-level employees who
monitor multiple patients re-
motely from a bunker area. These
individuals are trained to use the
computer software functions, such
as navigating the camera and alert
options and how to identify and
verbally intervene when they rec-
ognize unsafe patient behaviors.
The bunker where the telesitter
monitors at-risk patients should be
staffed 24 hours per day, 7 days per
week to ensure continual patient
coverage. The number of patients
a telesitter can observe at once var-
ies by each institution’s standards,
but the literature suggests that no
more than 12 patients is accept-
able (Votruba, Graham, Wisinkski,
& Syed, 2016). During the remote
video-monitoring admission, the
primary nurse must communicate
to the telesitter the patient’s name,
nurse contact information, reason
for admission to video monitor-
ing, and any potential hazards or
concerns to watch for (e.g., intra-
venous lines, catheters, seizure his-
tory). The telesitter must be able to
multitask, such as demonstrating
competencies using the PC while
monitoring the television screen,
allowing them to visualize the pa-
tients. Although there has been
little research describing the out-
comes of video monitoring, many
institutions have published or pre-
sented quality improvement data
supporting its use and have report-
ed a decrease in fall rates among
their monitored patients (Votruba
et al., 2016).
Figure. Algorithm to operationalize remote video monitoring; EEG = electroencephalogram.
486 Copyright © SLACK Incorporated
CLINICAL IMPLICATIONS FOR
REMOTE VIDEO MONITORING
Fall prevention requires multiple
interventions to be put in place si-
multaneously to help with prevent-
ing patient injury; having an extra set
of eyes to monitor patient activity
can always help. Many institutions
are faced with reducing sitter costs
and optimizing staffing despite the
pressure to remain productive and
cost effective and to maintain patient
safety. This new technology provides
an innovative fall prevention strategy
that allows the telesitter to moni-
tor more than one to two patients
at a time. Although predicting pa-
tients who are most at risk for falls
continues to be a
challenge, using an
algorithm or proto-
col to identify po-
tential remote video
monitoring patients
can be helpful in
deciding whether
or not to use this
technology for a
patient (Figure).
Finally, to have a
successful remote
video-monitoring
program as evidenced by decreased
fall-related safety outcomes and
continuous usage of the equipment,
operationalization must facilitate
open communication between the
telesitter and the direct care staff.
One must remember that the telesit-
ters are not able to intervene directly
with the patient as they once did as
safety sitters, so they rely heavily on
the prompt clinical staff responses
when called. There are a few chal-
lenges that have been identified and
should be addressed before operat-
ing a remote video-monitoring pro-
gram. However, the benefits of the
program outweigh those challenges
(Table).
CONCLUSION
Remote video monitoring is not
the solution to end patient falls;
however, it is an additional resource
that can be used in the clinical ar-
senal of fall interventions. Using
this new technology in conjunction
with other interventions that have
been shown to reduce patient falls
could be promising in improving
fall-related patient outcomes and sit-
ter costs.
REFERENCES
Brown, D., & Wollosin, R. (2013). Safe-
ty culture relationships with hospi-
tal nursing-sensitive metrics. Jour-
nal of Healthcare Quality, 35, 61-74.
doi:10.1111/jhq.12016
Burtson, P., & Vento, L. (2015). Sitter re-
duction through mobile video moni-
toring. The Journal of Nursing Ad-
ministration, 45, 363-369. doi:10.1097/
NNA.0000000000000216
Rochefort, C., Ward, L., Ritchie, J., Gi-
rard, N., & Tamblyn, R. (2012). Patient
and nurse staffing characteristics associ-
ated with higher sitter use costs. Journal
of Advanced Nursing, 68, 1758-1767.
doi:10.1111/j.1365-2648.2011.05864.x
Votruba, L., Graham, B., Wisinski, J., & Syed,
A. (2016). Video monitoring to reduce
falls and patient companion costs for adult
inpatients. Nursing Economic$, 34, 185-
189.
TABLE
BENEFITS AND CHALLENGES WITH REMOTE
VIDEO MONITORING
Benefit Challenge
Patient safety and fall
and injury prevention.
Adequate wireless capabilities.
Potential reduction in
sitter costs.
Effective communication between
telesitter and direct care staff.
Dedicated staff to moni-
tor patients.
Self-directed telesitters for 24/7
staffing.
Reproduced with permission of the copyright owner. Further reproduction prohibited without
permission.
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Sitter reduction through mobile video monitoring
  • Jan 2015
  • J NURS ADMIN
  • 363-369
  • P Burtson
  • L Vento
Burtson, P., & Vento, L. (2015). Sitter reduction through mobile video monitoring. The Journal of Nursing Administration, 45, 363-369. doi:10.1097/ NNA.0000000000000216