By Paul Gallese
Automated patient safety monitoring systems using electronic and computerized technology to measure hand hygiene compliance and the efficacy of nursing staff workflow have been introduced into the patient safety marketplace. This post describes how these patient safety systems work and how they can produce useful, actionable data for healthcare organizations that use automated monitoring to improve hand hygiene compliance or as part of purposeful rounding strategies to prevent falls, pressure ulcers, venous thromboembolism (VTE), and adverse drug events.
Automated, or electronic, systems can monitor hand hygiene performance and nurse rounding workflow 24/7 on all shifts without observer bias or the Hawthorne effect – the alteration of behavior by the subjects of the study due to their awareness of being observed.
Automated workflow monitoring systems also gather significantly more data than direct observation, which was the monitoring compliance standard adopted by the World Health Organization (WHO) in 2009. Introduced after this adoption and gaining in popularity, automated systems can summarize larger amounts of data than direct observation and provide actionable feedback to improve patient safety through customizable reports made available at individual care provider, shift, unit and organizational levels. Another advantage is the limited personnel resources automated systems require once implemented compared to direct observation strategies (Boyce, 2017).
A new report from World Business Research and Conversa Health titled, “Healthcare 2020: How Automated Patient Experiences Will Transform the Landscape,” says:
82 percent of respondents see value in using automated healthcare solutions to gather patient-generated health data.
79 percent will be working on integrating automated healthcare solutions within the next two years.
49 percent have either integrated or have begun to integrate patient-generated health care into their initiatives.
The latest technology advancement designed to help reduce HAIs and HACs
Automated systems represent one of the latest technological advancements within the evolution of solutions designed to address healthcare-acquired infections (HAIs) and healthcare-acquired conditions (HACs). After creating awareness of the importance of hand hygiene and other preventive measures, most healthcare organizations proceed along a continuum of actions they can embed into the safety culture and measure; most organizations start with simple compliance reminders and advance to direct observation programs followed by more sophisticated automated systems.
Ellingson et al. (2014) recommends exploring automated systems as an adjunct to or as a replacement of direct observation. Boyce points out that combining automated monitoring with observational methods in a multimodal strategy may provide the best information because many automated systems use the entering and exiting of patient rooms as proxies for hand washing moments 1, 4 and 5 of the World Health Organization’s “five moments” of hand hygiene (2009). Moment 1 is washing hands before touching a patient, moment 4 washing hands after touching a patient, and moment 5 washing hands after touching patient surroundings. As healthcare facilities invest in and implement these systems, many other organizations wait to see the impact these systems will have on hand hygiene compliance, nurse rounding efficacy, and HAI rate reduction.
Automated systems have improved hand hygiene compliance and reduced infection rates
The results of various studies have been promising. Michael et al. (2017) reports that an automated system with immediate feedback caused a rapid and sustained improvement in hand hygiene compliance. For example, one unit improved from 54 percent compliance over 12 months based on 88 direct observations to 98 percent compliance over 12 weeks based on 140,000 automated observations.
Another study of an automated system shows an increase of hand hygiene compliance of 25.5 percent, a decrease of healthcare-associated MRSA infections of 42 percent from baseline, and a savings of $434,000 over the study timeframe (Kelly et al., 2016). The results also demonstrate how continual feedback from the data led to staff engagement and sustained improvement. “Across the entire hospital, periods of improved hand hygiene compliance led to lower infection rates,” the authors state. “We believe the monitoring system aided nursing leadership’s ability to drive change and improve staff performance, by providing real-time reliable (compliance) data. Continuing feedback allowed for ongoing conversation with frontline nursing staff, and unit-level data allowed for unit-level solutions because staff engagement with the data led to strategic decisions, which resulted in consistent, sustained improvement in hand hygiene performance.”
Boyce explains that automated compliance monitoring systems currently fall into three major categories: 1) activity monitoring systems that monitor dispenser use and the entry and exit of individuals into a patient room, 2) systems that include the wearing of electronic badges or sensors by healthcare providers, and 3) camera-based systems that determine compliance rates by visual review of videos. In addition, Kelly (2016) and Azim (2016) described a badge-less electronic system that captured hand hygiene events from dispensers and transmitted data via a radio frequency network to a cloud-based database.
What all these automated monitoring systems have in common is that they are “capable of capturing 100 percent of hand hygiene events, not a statistically insignificant sample, as is the case with direct observation,” Alper (2016) explains. “Observer bias and the Hawthorne effect are thus eliminated.”
Personal feedback empowers care providers
Son et al., (2011) raises another key advantage of electronic systems, saying that they empower healthcare providers within a group or unit with “the responsibility to identify their own obstacles and barriers to proper hand hygiene, create action plans to remove them, and establish their own goals that can lead to sustainable improvement over time. . . They allow for tracking and reporting on an individual healthcare worker’s performance, so they can receive personal feedback . . . Most importantly, electronic monitoring systems tell the truth, better enable accountability, and can drive real performance improvement from an honest baseline. Accurate, reliable, timely, and actionable data is the key benefit.”
Automated systems do present their own challenges, however. Given the required learning curve, they require an upfront investment of capital, resources and time, as well as a maintenance plan to ensure system continuity (Edmisten et al., 2017). Acceptance of automated systems by care providers is influenced by concerns over privacy and how compliance data will be handled by administrators (Boyce, 2017).
The Vitalacy system is an automated solution that combines Internet of Things (IoT) technology with artificial intelligence (AI) to provide a continual, real-time platform that tracks caregiver workflow. These capabilities enable healthcare organizations to monitor care provider activities that, if performed consistently, can reduce HAIs and HACs.
By creating this patient “safety sphere,” Vitalacy provides a consistent and durable location-based workflow tracking system that helps healthcare organizations achieve better compliance results and patient safety. Learn more about how the Vitalacy system can improve patient safety results by reading our new white paper -- “Finding New Ways to Prevent Healthcare-Acquired Infections and Conditions.” Vitalacy offers an advanced automated system that can track how long care providers wash their hands and how often throughout the day, as well as monitor the efficacy of nurse rounding. Learn more about our automated monitoring platform.
Alper P. To do no harm, rethink how to measure hand hygiene. Patient Safety & Quality Healthcare, May/June 2016;13(3):30-34.
Azim S, et al. Introducing automated hand hygiene surveillance to an Australian hospital: Mirroring the HOW2 benchmark study, American Journal of Infection Control, 2016; 44:772-776.
Boyce JM. State of the Science Review: Electronic monitoring in combination with direct observation as a means to significantly improve hand hygiene compliance. American Journal of Infection Control, May 2017;45(5):528-535.
Edmisten C, et al: Implementing an electronic hand hygiene monitoring system: Lessons learned from community hospitals. American Journal of Infection Control, Aug. 1, 2017;45(8):860-865.
Ellingson K, Haas J, Aiello A, Kusek L, Maragakis L, Olmsted R, Perencevich E and Polgreen P. Strategies to Prevent Healthcare-Associated Infections through Hand Hygiene. Infection Control and Hospital Epidemiology, August 2014;35:8.
Kelly JW, et al: Electronic hand hygiene monitoring as a tool for reducing healthcare-associated methicillin-resistant Staphylococcus aureus infection. American Journal of Infection Control, 2016;44:956–957.
Michael H, et al: Durable improvement in hand hygiene compliance following implementation of an automated observation system with visual feedback. American Journal of Infection Control, 2017;45:311-313.
Son C, et al: Practically speaking: Rethinking hand hygiene improvement programs in healthcare settings. American Journal of Infection Control, 2011;39(9):716-724.
Vitalacy, Inc. Finding new ways to prevent healthcare-acquired infections and conditions. (2019).
World Business Research and Conversa Health. Healthcare 2020: How Automated Patient Experiences Will Transform the Landscape (2018).
World Health Organization 2009. Guidelines on hand hygiene in healthcare. WHO. Geneva.