1. The Impact of Centralized Monitoring Katie M. Klein Viterbo University

2.  Does centralized monitoring have a negative impact on the ability to provide personalized care to patients?  P: Nurses, Physicians, and their patients  I: Ability to provide personalized care to patients without centralized monitoring  C: Ability to provide personalized care to patients while utilizing centralized monitoring  O: No negative impact on personalized care

3.  Outside of L&D:  Telemetry: Telemetry techs utilize centralized monitoring to provide 24/7 observation from a specialized area set-up specifically for this purpose.  Video Monitoring: Initiated to reduce cost of employing CNAs for “sitter” in patient rooms where 1:1 observation is required.  Security: Used in several different businesses to allow large areas of space to be protected by a small number of security staff.  Inside L&D:  Fetal Monitoring: Used to remotely view the fetal heart rate tracing as well as the contraction pattern. Monitors located in each room and at the nurses stations. May be viewed outside the hospital by providers.

4.  Are you familiar with centralized monitoring?  How long have you been utilizing centralized monitoring?  Has centralized monitoring impacted the service you provide to patients and if so, how?  Personalization of care is important in labor and delivery. Has centralized monitoring impacted this type of care?  What is your favorite or least favorite aspect of centralized monitoring?

5.  2 – currently in BSN completion program  2 – BSN  2 – CNAs  2 – ADN  1 – Physician

6.  4 – Obstetrics (including the physician)  2 – Medical / Surgical  1 – ICU  1 – Cardiac Care  1 – Rehab

7. Years# of nurses# of physicians 0-53_ 5-102_ > 1031

8.  All nine interviewees were familiar with centralized monitoring.  The length of time utilizing this type of system ranged from 6 months to over 10 years!  When questioned about whether or not centralized monitoring has had an impact on the service they provide, all 9 agreed that it does have an impact.

9.  How does it impact the service you provide?  “In OB, it safely allows me to monitor my patient without hovering next to them in the room. It also allows me to catch things quicker!”  “In the cardiac unit, knowing there were always eyes on my patient’s telemetry was so comforting. There were telemetry techs who were specifically trained and watched the monitors 24/7. I don’t know what they did before this type of technology, but I’m sure outcomes have greatly improved since using it!”  “It has decreased the number of times I’ve needed to come into the hospital in the middle of the night. I can pull-up the strip at home and feel confident that I’m making the right decision over the phone.”  “It impacts my patients because I do more of my charting in the room, next to the bed… I wonder if they feel like I’m less attentive to them and more attentive to my computer.”

10. Concerns:  Charting in front of the patient may have a negative impact on his/her perception of the nurse. Possibly feeling like the nurse is paying more attention to the computer than the needs of the patient.  Monitoring from the nurses station allows the nurse to spend less time in the room, which may lead to the patient feeling alone or deserted.  Nurses may feel like the focus is now on the centralized monitoring system, rather than focused on the patient.

11.  All 9 healthcare personnel listed safety as their #1 favorite aspect of centralized monitoring! Other favorites:  Efficiency of charting  Accessibility  Remote access  Customization of the system  Increased accuracy

12.  Requires less patient contact  Possibility of HIPPA breech is greater with monitors at nurses station continually showing patient information.  “I hate computers”  We may become more reliant on alarms and technology than on nursing skills and assessments.  Glitches in the system… the technology is far from perfect!

13.  The use of video monitoring is becoming more popular as hospitals attempt to cut costs.  Centralized Video Monitoring is replacing “sitters” for 1:1 observation patients.  Telemetry observation booths have been used for years, but now this type of monitoring is being utilized in other areas… including OB.  Results: “Timely and appropriate management of Category III heart rate tracings. It is expected that a decrease from time of onset of this tracing to time of decision to incision will decrease” (Garrison-Isler, Gilbert, & Miller, 2014, p. S11).

14.  Has centralized monitoring of any type impacted the care you provide?  Have you or one of your family members been on the other end of this type of monitoring, and if so, has that experience impacted your perception of centralized monitoring?

15. Garrison-Isler, C. S., Gilbert, L., & Miller, C. (2014). Do you see what I see? Using telemedicine in obstetrics to improve patient safety. JOGNN: Journal of Obstetrics, Gynecology & Neonatal Nursing, 43 (Supp 1), S11-S11. Jeffers, S., Searcey, P., Boyle, K., Herring, C., Lester, K., Goetz-Smith, H., & Nelson, P. (2013). Centralized video monitoring for patient safety: A Denver health lean journey. Nursing Economics, 31(6), 297-306. Williams, D., Ivey, T., Benton, T., & Rhoads, S. (2010). Another set of eyes: Remote fetal monitoring surveillance aids the busy labor and delivery unit. JOGNN: Journal of Obstetrics, Gynecology & Neonatal Nursing, 39, S41-S41.