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Implementation of wireless vital signs monitoring on the general ward: Nursing practice towards alarm strategy

Vlaskamp, L.B. (2019) Implementation of wireless vital signs monitoring on the general ward: Nursing practice towards alarm strategy.

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Abstract:Introduction. Nurses measure vital signs intermittently on a general ward, typically once every eight hours. This low frequency of monitoring may lead to failure-to-rescue by missing early change in vital signs. Technological advances nowadays allow continuous monitoring of vital signs on a general ward since these devices are wireless. We aimed to find an alarm strategy that can be used in these wireless continuous vital signs monitoring devices on a general ward to detect patient deterioration in time. Methods. First, we performed 4 semi-structured interviews and 20 surveys among general ward nurses working with the Sensium Vitals system in the Amsterdam UMC to investigate their attitude towards continuous monitoring devices. Second, we retrospectively evaluated the alarm strategy of the Sensium Vitals system by studying vital sign data and medical records of 39 medium to high risk post-surgical patients included from the Shepherd trial between December 2018 and March 2019. We studied the percentage of adverse events preceded by Sensium Vitals alarms and the number and type of the Sensium Vitals alarms. Third, in the same cohort, we evaluated the vital signs data around adverse events and around different types of alarms. Fourth, recommendations from the three abovementioned studies were translated into adjustments for the Sensium Vitals alarm strategy and retrospectively implemented in the self-reproduced Sensium Vitals alarm model to find the optimal alarm strategy. Results. Nurses showed a positive attitude towards the Sensium Vitals system, but prefer two modifications: less alarms and using personalized threshold values for generating alarms. With the current Sensium Vitals alarm strategy, 37% of adverse events (n=7/19) were preceded by alarms. Of all alarms (n=83), 58% was classified as false positive. Two third of the adverse events were preceded by positive trendlines in the data and data characteristics differed between the different types of alarms. We made nine recommendations to improve the alarm strategy. Implementing the post-operative course in the original alarm strategy led to an increase in sensitivity (0.37 to 0.53) and implementing personalized threshold values led to the lowest amount of false positive alarms (n=48 to n=24). Conclusion. The alarm strategy for continuous monitoring can detect one third of adverse events in post-surgical patients, but most alarms are false positive. We recommended adjustments to the alarm strategy leading to higher sensitivity or a lower number of false positive alarms. To find the optimal alarm strategy, it is important to determine the ratio between true positive and false positive alarms.
Item Type:Essay (Master)
Faculty:TNW: Science and Technology
Subject:44 medicine, 50 technical science in general
Programme:Technical Medicine MSc (60033)
Link to this item:http://purl.utwente.nl/essays/80098
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