Enhancing Patient Safety Through an Integrated Internet of Things Patient Care System: Large Quasi-Experimental Study on Fall Prevention.

BACKGROUND: The challenge of preventing in-patient falls remains one of the most critical concerns in health care. OBJECTIVE: This study aims to investigate the effect of an integrated Internet of Things (IoT) smart patient care system on fall prevention. METHODS: A quasi-experimental study design is used. The smart patient care system is an integrated IoT system combining a motion-sensing mattress for bed-exit detection, specifying different types of patient calls, integrating a health care staff scheduling system, and allowing health care staff to receive and respond to alarms via mobile devices. Unadjusted and adjusted logistic regression models were used to investigate the relationship between the use of the IoT system and bedside falls compared with a traditional patient care system. RESULTS: In total, 1300 patients were recruited from a medical center in Taiwan. The IoT patient care system detected an average of 13.5 potential falls per day without any false alarms, whereas the traditional system issued about 11 bed-exit alarms daily, with approximately 4 being false, effectively identifying 7 potential falls. The bedside fall incidence during hospitalization was 1.2% (n=8) in the traditional patient care system ward and 0.1% (n=1) in the smart ward. We found that the likelihood of bedside falls in wards with the IoT system was reduced by 88% (odds ratio 0.12, 95% CI 0.01-0.97; P=.047). CONCLUSIONS: The integrated IoT smart patient care system might prevent falls by assisting health care staff with efficient and resilient responses to bed-exit detection. Future product development and research are recommended to introduce IoT into patient care systems combining bed-exit alerts to prevent inpatient falls and address challenges in patient safety.

Implementation and experience of an innovative smart patient care system: a cross-sectional study.

BACKGROUND: Although a patient care system may help nurses handle patients' requests or provide timely assistance to those in need, there are a number of barriers faced by nurses in handling alarms. METHODS: The aim of the study was to describe the implementation and experience of an innovative smart patient care system (SPCS). This study applied a cross-sectional descriptive design. We recruited 82 nurses from a medical center in Taiwan, with 25 nurses from a ward that had introduced an SPCS and 57 nurses from wards that used the traditional patient care system (TPCS). The major advantages of the SPCS compared to the TPCS include the specification of alarm purposes, the routing of alarms directly to the mobile phone; the capability of immediate communication via phone; and three-stage bed-exit alerts with low false alarm rate. RESULTS: Approximately 56% of nurses in the TPCS wards perceived that the bed-exit alert was easily ignorable, while this rate was reduced to 32% in the SPCS ward. The immediate communication via phone was considered as the most helpful function of the SPCS, with a weighted average score of 3.92/5, and 52% of nurses strongly agreed (5/5) that this function was helpful. The second-highest ranked function was the three-stage bed-exit alert, with an average score of 3.68/5, with approximately 24% of nurses strongly agreeing (5/5) that this function was helpful. The average response time using TPCS was 145.66 s while it was 59.02 s using the SPCS (P < .001). Among the 110 observed alarms in the SPCS ward, none of them were false bed-exit alarms. In comparison, among 120 observed alarms in the TPCS wards, 42 (35%) of them were false bed-exit alarms (P < .001). In this study, we found that 30.91% of alarms using SPCS were processed because nurses received and responded to the alert via mobile phone. CONCLUSIONS: A smart patient care system is needed to help nurses make more informed prioritization decisions between responding to alarms and ongoing tasks and finally assist them in adjusting their work in various situations to improve work efficiency and care quality.

[Using an Indicator-Based Reminder of Catheter Removal to Effectively Decrease Catheter-Associated Urinary Tract Infections in General Medical Patients].

BACKGROUND: Urinary tract infections are a common iatrogenic infection in healthcare institutions. Catheter-associated urinary tract infections (CAUTIs) may result in sepsis, prolonged hospitalization, additional hospital costs, and mortality. PURPOSE: The study examined the efficacy of an indicator-based reminder of catheter removal in decreasing CAUTIs among patients in the general medical ward. METHODS: A two-group, quasi-experimental design was used. The intervention strategies included daily implementation of the indicator-based reminder procedure and standardized Foley care and a teaching program for all staff nurses. All patients who received Foley during hospitalization were included, with the exception of those with CAUTI at admission. Seventy-five patients were enrolled from five wards in a medical center, with 33 assigned to the control group and 42 assigned to the experimental group. RESULTS: CAUTIs were diagnosed in 7 participants (16.7%) in the experimental group and 15 participants (45.5%) in the control group. The differences were statistically significant (p = .014). The mean number of Foley days was 14.73% less in the experimental group, with 11.0 for the experimental group and 12.9 for the control group. The incidence density of CAUTIs was 15.2% for the experimental group and 35.3% for the control group. CONCLUSIONS: The present study supports that an indicator-based reminder of catheter removal decreases the incidence rate and incidence density of CAUTIs. Medical personnel in the general medical ward may use this reminder to detect unnecessary indwelling of urinary catheters and to remove Foley catheters as early as feasible in order to prevent CAUTIs.

The experiences of adult ventilator-dependent patients: a meta-synthesis review.

Studies exploring the perceptions of patients whose lives are maintained by mechanical ventilation highlight the stressful nature of this type of experience. The objective of this meta-synthesis study was to describe the nature of the experience of adult ventilator-dependent patients. A systematic literature search of English and Chinese databases was undertaken, covering the period between 1970 and 2012. Qualitative research findings were extracted and pooled using the Joanna Briggs Institute Qualitative Assessment and Review Instrument. A total of 1004 papers were identified from various database and hand searches. Nineteen papers were critically appraised and 16 met inclusion criteria. Five meta-synthesis themes emerged from the analysis: (1) the feelings of fear due to being dependent on a ventilator and the loss of control of life; (2) disconnection with reality; (3) impaired embodiment; (4) construction of coping patterns; (5) trust and caring relationship. Suggested implications for practice include enhancing the trust relationship with health professionals, as well as nursing actions throughout the suction procedure relating to release of patient's psychological distress and empowering their resilience factors.

Implementation and Evaluation the Effectiveness of the Bar-coded Medication Administration System in a Medical Center.

The aim of study was to implement and evaluate the effectiveness of the BCMA systems in medical center. A convenience sample of totally 48 medical-surgical units and 800 staff nurses were recruited to evaluate the systems in 2010. The nurses' perception of the BCMA/eMAR systems were accorded with clinical procedures, guarded the accuracy of patient identification and medication administration processes, and greater than 70% of nurses were willing to use the BCMA/eMAR systems.

Evaluating the suicide risk-screening scale used by general nurses on patients with chronic obstructive pulmonary disease and lung cancer: a questionnaire survey.

AIM: The aim of this study was to evaluate the interview version of the screening of risk for suicide with redefined items for the hospitalised patients. BACKGROUND: Patients hospitalised in general hospitals with physical illnesses performed suicidal acts more rapidly after admission. DESIGN: A two-hour screening skills training course was provided to general nurses caring for hospitalised patients. The patients were rated by trained nurses according to the screening of risk for suicide. Then, patients did self-rating of repulsion of life scale and symptom distress. The participants were 54 trained nurses and 205 patients, 76 of whom had chronic obstructive pulmonary disease and 129 had lung cancer. METHODS: The trained nurses used the screening of risk for suicide to screen patients and compared their results with their trainers within 24 hours for inter-rater consistency, followed by patients' self-rating. RESULTS: The inter-rater reliability between nurses and their trainers was 0·85. The screening of risk for suicide rated by nurses correlated significantly with repulsion to life and symptom distress rated by patients. There were 26·3% (20) of patients with chronic obstructive pulmonary disease and 14·0% (18) of patients with lung cancer who showed moderate-to-high suicide risk, most of them having poor social support. The nurse's score on patient with chronic obstructive pulmonary disease was higher than patient's self-rating. CONCLUSIONS: The screening of risk for suicide was useful in alerting the general nurses to high-risk patients and the nurse' screening collected more in-depth data than patients' self-rating. It is suggested that this suicide risk-screening training should incorporate into continuing education in general hospital and the use of Screening of Risk for Suicide incorporating into new patient nursing assessment. RELEVANCE TO CLINICAL PRACTICE.: The two-hour suicide risk-screening training could renew the general nurse skill of risk screening for the hospitalised patients.

The use of virtual reality computer simulation in learning Port-A cath injection.

Cost-benefit management trends in Taiwan healthcare settings have led nurses to perform more invasive skills, such as Port-A cath administration of medications. Accordingly, nurses must be well-prepared prior to teaching by the mentor and supervision method. The purpose of the current study was to develop a computer-assisted protocol using virtual reality (VR) in performing Port-A cath as a training program for novice nurses. A pre-tested and post-tested control group experimental design was used in this study. Seventy-seven novice nurses were invited from one large medical center hospital in North Taiwan. Thirty-seven and forty nurses were randomly assigned to experimental and control groups. First, we designed a 40 minute port-A cath injection VR simulation. Then, the experimental group practiced this simulation two times over 3 weeks. The control group attended the traditional class. The post-test 1 was right after completion of the simulation practice. The post-test 2 was after the second simulation practice in 3 weeks. The results showed that most novice nurses lacked Port-A cath experience both in the classroom and during the period of their practice training. The knowledge score regarding the Port-A cath technique was significantly higher in the nurses that participated in the simulation training than in the control group. The novice nurses were most satisfied with the reduction in their fear of performing the Port-A cath technique and their enhanced clinical skills. VR simulation significantly reduced error rates and increased correct equipment selection, showing that nurses who participated in the simulation may be better prepared for inserting Port-A cath.

Patient falls and open visiting hours: a case study in a Taiwanese medical center.

This study investigated the linkages between patient falls and open visiting hours in an acute care setting in Taiwan. The activities of the accompanying family members/aides when patients fell were analyzed. More than 35% of the family members/aides who were watching patients were ineffective in preventing the falls.