Implementing a non-contact method of monitoring patients

Christina Santana-Smith, Senior Transformation and Delivery Lead, Central and Northwest London Foundation Trust and Digital Pioneer Fellow.

Overview of project:

• Oxehealth is a digital care assistant that allows for non-contact monitoring of patients, including basic vital signs and activity alerts, to improve the safety and experience of both patients and staff.
• At CNWL, have installed Oxehealth in mental health settings across all Older Adult inpatient wards, Psychiatric Intensive Care Unit (PICU) wards, Seclusion rooms, and Health Based Places of Safety (HBPoS) in the Trust.
• Oxehealth is now live in all 180 rooms across 6 inpatient sites included in the pilot. We have been shifting focus to supporting implementation, change management, and ensuring quality as we prepare for the transition to business as usual. We have also completed the mid-point benefits realisation data collection and analysis for all participating sites with very positive initial results based on patient and staff experience. We are currently preparing for the end-point benefits realisation data collection, which will begin next month an inform our final evaluation of the project as well as next steps.

Having the Oxehealth system makes me have a better sense of wellbeing because I feel more, not watched, but secure. Staff have access to see if anything is going wrong at any time.

– Patient

In cases where we have given rapid tranquilisation medication the system has been particularly useful for monitoring the physical health of patients. Before, if a patient was agitated and we were unable to enter the room, we would manually try to record breaths through the door. Now with Oxehealth we get accurate recordings of both their breathing and pulse rates.

– Clinician

Impact of project:

• Improved safety on the wards: there is improved safety on the wards because staff can prevent and respond more quickly to safety-related incidents on the wards. 93% of patients reported feeling safer in the bedrooms because of Oxehealh, and 98% of staff felt the system increased patient safety in bedrooms on the wards.
• Improved quality of sleep:Staff can monitor patient’s health during the night without entering their rooms and disturbing their sleep, thus facilitating sleep hygiene. 85% of staff found the system effective in reducing sleep distance in patient bedrooms on the ward, and 89% of staff found the system effective in reducing sleep disturbance in HBPoS/Seclusion rooms.
• Reduced falls/early alerts to falls on Older Adult wards: staff can prevent and response more quickly to falls on Older Adult wards. 82% of staff found the system effective in reducing falls in patients’ bedrooms.
• Enhanced physical health monitoring: Oxehealth enables staff to identify physical health deterioration in patients more easily, support them in monitoring patients when they refuse physical health checks, and adhere to physical heath monitoring post rapid tranquilisation. 89% of staff felt the system was effective in identifying physical health deterioration in patients’ bedrooms (86% for HBPoS/seclusion rooms), and 95% of staff felt the system made it easier to adhere to physical health check policy post rapid tranquilisation in HBPoS/Seclusion rooms (90% for patient bedrooms on the wards).
• Improved quality of care:  Patients feel the system has improved quality of care on the wards with 90% feeling their wellbeing was better and 90% feeling staff provided better care with the system in their bedrooms. Similarly, 91% of staff on the wards and 95% of staff in HBPoS/Seclusion rooms felt the system increased the quality of care provided to patients.

Statistics:

• Estimated number of patients to have benefited: All single-occupancy bedrooms in the Older Adults and PICU wards across the Trust, as well as seclusion rooms and HBPoS (total of 180 rooms).
• Estimated number of NHS/social care staff to have benefited: 297 inpatient ward staff plus additional HBPoS and seclusion staff.

I think the system has impacted the quality of care we give to patients. In the sense that we’re not actually having to go and keep waking the patient up when you’re doing checks. It lets them rest. We are also able to assist them when they need us straight away. The system helps with better care in that way.

– Clinician

Yes, it definitely makes me feel safer in my room. I have good health but other patients in the ward I think they would find it very useful.  If something was to happen to me, I know that the staff would be able to track me and get to me as fast as possible.

– Patient

Key learnings from the project delivery to date:

• It is imperative that we not forget the people who are involved in and impacted by digital projects. Principles of co-production, engagement, and transparency are critically important for the adoption and acceptance of digital innovation in health care. Engagement with service users/carers and front-line staff ideally should be part of all decision-making processes surrounded whether/where/how digital technologies will be piloted and implemented.
• Change management is something that needs to be done proactively, intentionally, and over the life cycle of the whole projects. In order for a digital solution to be effectively implemented, the work with staff and service users/carers has to start before Go-Live and continue sufficiently after Go-Live to make sure the change is truly embedded into business as usual.
• Plan for a robust benefits realisation process at the start and see it through. This is important both for effectively evaluating the success and impact of the digital project, and for bringing key decision-makers along with you- including the sceptics- when thinking about the future of the project and other digital innovation projects.