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Ugochi NwuluSenior Research Associate
Patient bedside monitoring at the Queen Elizabeth Hospital Birmingham
Birmingham and Black Country CLAHRC Theme 9: Improving Patient Safety –
Studying an evolving IT system
This theme evaluates the implementation of various clinical computing technologies in
University Hospital Birmingham NHS Foundation Trust that aim to improve safety and quality of care
Outline of presentation
Bedside monitoring: What, When, Who and Why
Interventions which improve patient outcomes: by improving patient bedside monitoring
What happens at UHB: an overview of PICS and the electronic observation form
Bedside monitoring in the future: advanced computerised solutions
Bedside monitoringWhat is monitored?
• TPR charts: temperature, pulse, respiratory rate, blood pressure & oxygen saturation most frequent measurements taken by health care professionals
• These VITAL SIGNS are important indicators of the body’s response to stressors and form part of a routine physical assessment
• Additionally – measures of consciousness (AVPU), urine output, pain scores are part of bedside monitoring
• Other aspects of bedside monitoring are often needed in different circumstances – after certain procedures
Bedside monitoringWhen to monitor?• On admission• According to ward/unit/specialty• Before and after a procedure/surgery• Before and after blood transfusions• As indicated with medications
NICE guidance recommends that all inpatients must havetheir vital signs recorded as a minimum every 12 hours but the
frequency should be increased when abnormal physiology is detected.
ALSO!Changes in patient's physical condition i.e. painPatient in distress or family reports a changeIntuition/clinical experience
Acutely ill patients in hospital: recognition of and response to acute illness of adults in hospital.CG50 National Institute for Health and Clinical Excellence 2007.
Bedside monitoring
Who monitors?• Observations are usually taken by nursing staff – both registered
and non registered.• Can often be delegated to more junior or less experienced
members of the team
Important that staff are aware of the significance of vital sign recording, and have the knowledge and skill to interpret them to ensure patient safety
Safer Care for the Acutely Ill Patient: Learning from Serious Incidents. National Patient Safety Agency 2007
Bedside monitoring
Why is it important?
• Important to provide baseline set of vital signs to identify subsequent changes in a patient’s condition
• Critical events (cardiac arrests, deaths & unplanned ICU transfers) are often preceded by physiological deterioration (and often signs of physiological deterioration!)
Bedside monitoring can be perceived as basic and routine BUT plays a vital role to ensure safer patient care and early recognition of deterioration.
StaffEducation
Response
Call for help
Recognition
Monitoring
Reducing harm from deterioration
*adopted from the Chain of Prevention © Gary Smith
Record vital signs
Competence in recording/understanding physiological
observations
*adopted from the Chain of Prevention © Gary Smith
StaffEducation
Response
Call for help
Recognition
Monitoring
Response strategyCritical Care Outreach
Medical Emergency Teams
Escalation protocol
Communication tool
Interventions to improve patient outcomes
Interventions to improve patient outcomes
The Early Warning Score System
3 2 1 0 1 2 3
HR <30 30-39 40-49 50-99 100-109 110-129 ≥130
sBP 70-79 80-99 100-199 ≥200
O2 Sats <85 85-89 90-92 ≥93
RR <9 9-20 20-30 31-35 ≥36
TEMP <34 34 35 36-37 >38 ≥39
CNS A V P U
“Track and trigger” systems
•Used on paper-based and electronic observation charts
•Periodic observation of selected vital signs (the “tracking”) with pre-determined criteria (the “trigger”) for requesting the attendance of more experienced staff
*adopted from the Chain of Prevention © Gary Smith
StaffEducation
Response
Call for help
Recognition
Monitoring
An Early Warning Score
Interventions to improve patient outcomes (2)...
PICS is a rules based system for managing clinical investigations,
prescribing and drug administration
The use of PICS in the Trust
PICS is the Trust’s locally developed electronic
prescribing solution that is available on every
computer desktop in the Trust
PICS also has -
A change in prescribing -
From this to this
using this
A change in vital signs recordingFrom this To this
Using this
2007: Development of electronic form2009: Go-live in May. Pilot ward was Burns and Plastics2012: Now in majority of wards
Education Response
Call for help
Recognition
Monitoring
Electronic observation form
Alerts to doctors and nurses based on severity of SEWS
Emails to Critical Care Outreach
*adopted from the Chain of Prevention © Gary Smith
Ready access to electronic data capture
What next for bedside monitoring?Coming soon - a National Early Warning Score (NEWS)
Advanced computerised solutionsComing soonish - Wireless Vital Signs Monitor*
The monitor tracks a patient’s HR and RR by beaming Doppler radar technology into their chest.
It uses radio frequency electromagnetic waves reflected from the body's surface and only requires that the white device face the patient to work.
* Kaiser Permanente's Garfield Health Care Innovation Centre
Advanced computerised solutions (2)Coming when? Body Sensors and Smart Phones to Implantable Biodegradable Sensors*
Continuous vital signs monitoring: a wrist-worn device that measures HR/PR, 3- or 5-lead electrocardiography (ECG), SpO2, BP, RR and skin temperature through body sensors
*GE Wireless Communication (http://www.nanotechgalaxy.com)
ViSi Mobile® by Sotera Wireless
Research opportunities...
Thank you!
For further information about Theme 9 please contact:
Principal investigator: Dr Jamie Coleman, [email protected]
Project manager: Miss Ugochi Nwulu, [email protected]