Truman Medical Centers (TMC) in Kansas City, Missouri, is an academic health center that provides accessible, state-of-the-art quality health care to its community regardless of the ability to pay. A key area of focus in support of this mission is preventing patient falls.
Falls are the most frequently reported adverse events in U.S. adult inpatient settings, affecting 700,000 to 1 million patients each year. 1 Many falls result in patient harm, longer hospital stays and increased costs.
TMC's nursing leaders tried mitigating fall risks by assigning patient care technicians (PCTs) to sit with patients, but observation needs are uneven, unpredictable and non-reimbursable by third-party payers. When observation needs climbed, nursing leaders had to move additional PCTs from direct patient care to sitter roles. Nurses often had to add PCTs' tasks to their workloads, making it more difficult to deliver the highest quality care.
Chief Nursing Officer Amy Peters, RN, MBA, understood nurses' frustration with the situation and wanted to make a change.
"We try to create the best possible environment for our patients and caregivers," she said. "Reallocating additional PCTs from their primary jobs to one-on-one patient observation underutilized their skills and shortchanged our care teams. We needed a more predictable, efficient way to keep our patients safe."
About more than technology
Peters and her team proposed implementing Cerner Patient Observer™ (CPO) to better address variability in observation needs. Nursing leadership created a safety assessment that, in concert with a falls risk assessment, determines whether patients can be observed virtually or should be monitored by PCTs.
CPO uses 3D cameras to track patient movement and alert centralized monitoring staff if patients move beyond bed or room zones, need assistance, or interfere with lines or medical devices. The solution allows virtual monitoring technicians to communicate with patients and share patient assistance alerts with care team members. The project quickly gained support from TMC's leaders and garnered excitement from nursing staff.
"The project was about more than technology," said TMC Executive Chief Administrative Officer Mitzi Cardenas. "We saw an opportunity to strategically improve efficiency, empower our care teams and support patient safety. It's an example of how we've aligned with Cerner to help advance our goals. We're here to deliver the best possible care to our community, and this felt like a smarter way to accomplish that."
TMC staff test-launched CPO in two of six medical-surgical and telemetry units, realizing rapid and sustained results that rippled through initial units and beyond.
"Our care teams felt a difference," said Director of Telemetry Services Angela Kline-Couch, RN, MBA, MSN. "PCTs could focus on their jobs, which immediately eased nursing workloads. As the project advanced, we began purposefully assigning patients with high observation needs to the pilot units. That really stretched the project's impact — reducing observation-induced strain across all of med-surg and telemetry."
Making connections to enhance patient safety
TMC integrated CPO with its electronic health record, Cerner Millennium®, and the solution nurses use for mobile messaging, directory and alerting functions, CareAware Connect™. Centralized observation staff document directly into Millennium, and care teams receive alerts on their Connect phones. The system sent more than 6,700 bed exit alerts to nursing staff over the last year, providing just as many opportunities for caregivers to prevent a potential fall and keep patients safe.2
In the year following implementation, observation staff efficiency across all medical-surgical and telemetry units grew 78 percent,3 while fall rates decreased 34 percent4 and falls with injury dropped 57 percent.5
"No one wants to be injured or hear that their loved one has been injured when they should be healing," said Kline-Couch. "We've reduced those injuries by more than half."
CPO has been so successful on TMC's pilot units that the organization plans to eventually place the tool in every patient room. In the meantime, nurses extend the project's reach using portable CPO cameras for patients who cannot be easily moved to units with wall-mounted cameras.
"We're excited to build upon the pilot's success," said Peters. "This project still has so much untapped potential. We're just getting started."
1 Estimate from Currie LM. Fall and injury prevention. In: Patient safety and quality. an evidence-based handbook for nurses. Rockville, MD: Agency for Healthcare Research and Quality; 2008. AHRQ Publication No. 08-0043. Available at: http://archive.ahrq.gov/professionals/clinicians-providers/resources/nursing/resources/nurseshdbk/CurrieL_FIP.pdf
2 CareAware alerts; from February 2018 – January 2019
3 Observation hours per paid sitter hours for all medical-surgical and telemetry units, comparing rate for August 2017 - January 2018 to rate for February 2018 – January 2019
4 Comparing total medical-surgical and telemetry fall rate for August 2017 - January 2018 to rate for February 2018 - January 2019
5 Comparing total medical-surgical and telemetry fall with injury rate for August 2017 - January 2018 to rate for February 2018 - January 2019