Abstracts
Continuous monitoring of vital signs on a hematology ward to prevent ICU-admission: a feasibility study
Inhoud:

    Auteur(s):

    Gerrie Prins1, Kristin Baas1, Erwin Ista2, Jasper van Bommel1, Diederik Gommers1

     

    1Department of Intensive Care Medicine, Erasmus University Medical Centre, Rotterdam University, Rotterdam, the Netherlands

    2Department of Internal Medicine, Erasmus University Medical Centre, Rotterdam University, Rotterdam, the Netherlands
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    Abstracts

    Continuous monitoring of vital signs on a hematology ward to prevent ICU-admission: a feasibility study

    Teaser: Continue monitoring van vitale parameters kan klinische verslechtering eerder detecteren en mogelijk IC-opnames voorkomen.  In deze studie hebben we gekeken naar de haalbaarheid van de implementatie van continue monitoring van vitale functies op een hematologie afdeling met behulp van Checkpoint Cardio. Succesvolle  implementatie bleek niet haalbaar vanwege het geringe patiëntencomfort en slechte acceptatie door de afdelingsverpleegkundigen. 

    Background : Vital signs of patients in general wards are usually monitored periodically by nurses, primarily during daytime. As a result, clinical deterioration in between two subsequent measurements may not always be detected resulting in unwanted outcomes i.e unplanned admission to the intensive care unit (ICU), longer length of hospital stay end increased mortality1. By implementing continuous monitoring, clinical deterioration can be detected in an earlier phase and might reduce workload for nurses and improved patient comfort because of fewer intermittent vital sign measurements,2.

    Aim: To determine feasibility, in terms of acceptability and system fidelity, of continuous vital signs monitoring in patients on a hematology ward

    Methods: An observational cohort study was performed. Patients were monitored continuously by the Checkpoint Cardio device as concept of regular care until discharge or refusal of participation.  Main outcomes were patient- and nurse acceptability and system fidelity assessed by using (USE) questionnaires, analyzing monitoring data and reviewing EMRs. 

    Results: 40 patients were monitored for a median of 95 hours and 57 minutes. 21 (52.5%) patients continued participation until discharge. 19 patients filled in the additional questionnaire.  52.6% considered the device comfortable, 68.4% felt safer, 47.4%  would wear the device during a next admission and 15.8% would consider wearing the device at home. Patient comfort was predominantly limited by the SpO2 ear sensor leading to soft tissues defects.

    17 nurses filled in the USE (Usefulness, Satisfaction and Ease of use) questionnaire. Overall, they found the device not useful, not easy to use and were not content with the device. They were slightly more positive about whether using the device was easy to learn. Nurse acceptability declined primarily due to technical difficulties, which mostly amounted to measurements considered as unreliable and problems with the battery of the device (such as not charging or running low unexpectedly).

    Conclusion: In this study the implementation of continuous monitoring with the Cardio Checkpoint device was not feasible due to meager patient comfort and poor nurse acceptability.

    Referenties

    1. Wood C, Chaboyer W, Carr P. How do nurses use early warning scoring systems to detect and act on patient deterioration to ensure patient safety? A scoping review. Int J Nurs Stud. 2019;94:166-78.
    2. Downey CL, Chapman S, Randell R, Brown JM, Jayne DG. The impact of continuous versus intermittent vital signs monitoring in hospitals: A systematic review and narrative synthesis. Int J Nurs Stud. 2018;84:19-27.