Feasibility of wireless continuous monitoring of vital signs without using alarms on a general surgical ward: A mixed methods study

Abstract

Background Wireless continuous vital sign monitoring by wearable devices have recently become available for patients on general wards to promote timely detection of clinical deterioration. Many continuous monitoring systems use conventional threshold alarm settings to alert nurses in case of deviating vital signs. However, frequent false alarms often lead to alarm fatigue and inefficiencies in the workplace. The aim of this study was to determine the feasibility of continuous vital sign monitoring without the use of alarms, thereby exclusively relying on interval trend monitoring. Methods This explanatory sequential mixed methods study was conducted at an abdominal surgical ward of a tertiary teaching hospital. Heart rate and respiratory rate of patients were measured every minute by a wearable sensor. Trends were visualized and assessed six times per day by nurses and once a day by doctors during morning rounds. Instead of using alarms we focused exclusively on regular vital sign trend analysis by nurses and doctors. Primary outcome was feasibility in terms of acceptability by professionals, assessed by the Usefulness, Satisfaction and Ease of Use questionnaire and further explored in two focus groups, as well as fidelity. Results A total of 56 patients were monitored and in 80.5% (n = 536) of nurses’ work shifts the trends assessments were documented. All deviating trends (n = 17) were recognized in time. Professionals (N = 46) considered continuous monitoring satisfying (4.8±1.0 on a 1–7 Likert-scale) and were willing to use the technology. Although insight into vital sign trends allowed faster anticipation and action upon changed patient status, professionals were neutral about usefulness (4.4±1.0). They found continuous monitoring easy to use (4.7±0.8) and easy to learn (5.3±1.0) but indicated the need for gaining practical experience. Nurses considered the use of alarms for deviating vital signs unnecessary, when trends were regularly assessed and reported. Conclusion We demonstrated that continuous vital signs trend monitoring without using alarms was feasible in the general ward setting, thereby avoiding unnecessary alarms and preventing alarm fatigue. When monitoring in a general ward setting, the standard use of alarms may therefore be reconsidered.

Wearable wireless continuous vital signs monitoring on the general ward

“…Other aspects of patient wearability such as proper adhesion of the device should also be considered, to ensure patients and are not hindered in their daily living. Moreover, nurses express a need to extend the range of validated vital signs that can be measured by patch sensors [65 ▪ ]. It is important to consider ease of use for nurses, and wearability for patients, when considering which parameters are most important to be measured and which can be determined in derivation.…”

“…combining vital sign data or other threshold settings) but did not reach a definitive alternative [73]. Another study examined the use of a CVSM system without the use of an alarm strategy and regular trend assessments of individual trends and aggregated hourly EWS scores by every nursing shift [65 ▪ ,74]. This method showed better rates of adoption and acceptability by professionals, although maintaining long-term adherence to proactive trend assessments is still a challenge [66].…”

“…In the meantime, it is important to consider other relevant patient outcomes when evaluating and expanding the use of CVSM systems to maximize their impact. An important observation in two recent studies was that using a CVSM system led to the delivery of additional nursing interventions, potentially resulting in more proactive care [65 ▪ ,97]. These include the administration of pain medication, for example, or breathing exercises, which are known to promote patient recovery [103,104].…”

Interpretation of continuously measured vital signs data of COVID-19 patients by nurses and physicians at the general ward: A mixed methods study

“…They were seldom wrong when indicating that a patient was becoming respiratory insufficient, but missed some cases that were less obvious. Nurses indicate that alarms are not needed when continuous data is regularly assessed [ 26 ] and might even lead to alarm fatigue [ 27 ]. However, alarms might be necessary to detect signs of deterioration that are currently missed by hospital professionals, provide decision support in case of moderate or uncertain deviations, or help to find those patients that need clinical assessment.…”

A Wireless Continuous Monitoring System for Vital Signs

“…Recent studies have demonstrated that VIKI mobile monitoring devices can be worn on the body, allowing for the measurement of physiological data such as heart rate (HR), blood oxygen levels, blood pressure (BP), respiratory rate (RR), and skin temperature (T) [8,9] . These devices not only offer great convenience in nursing work but also enhance the comfort of patient monitoring [10,11] . However, the current device requires multiple modules to collect comprehensive indicators and lacks a complete set of life monitoring devices to comprehensively measure physiological indicators.…”