San Antonio, TX—An electronic "facility board" situated on a wall in the nurses' station of a medical/surgical unit led to more clinical interventions for abnormal vital signs, a reduction in falls among high-risk patients, and more ordering of specialty beds, according to nurses from Cancer Treatment Centers of America (CTCA) at Eastern Regional Medical Center in Philadelphia, PA.
At the Oncology Nursing Society 41st Annual Congress, Jessica O'Driscoll, BSN, RN, HN-BC, said the facility board serves as a simple visual alert system for the entire treatment team.
"In a perfect world, we would all communicate effectively to meet the needs of each patient at all times. In reality, a disorganized and hectic day often occurs, leaving room for error. That's when technology comes in," she said. "Because of this tool, the nurses on the medical/surgical floor at CTCA implemented an electronic board to help bridge these communication issues."
The facility board is a compilation of data downloaded from the patient's electronic health record. It is situated on a wall at the nurses' station, where it is easily visualized for almost instant recognition of problem areas for each patient. Vital signs, along with risk factors for falls and pressure ulcers, are highlighted when they are outside acceptable parameters.
"Clinicians come into the unit and are able to get a quick picture of a patient's status," she said.
The electronic board has multiple uses:
- Rapid assessment of vital signs, which are frequently monitored postoperatively
- Visual display of the patient's status for discussion during multidisciplinary morning rounds
- Review of quality indicators, as a quick reference for the charge nurse
- Identification of patients with high Hendrich scores, for whom a fall risk bundle can be maintained.
Improvement in the prompt identification of patient deterioration and risk was analyzed using 2 months of postimplementation data on abnormalities or changes with vital signs, Hendrich scores, and Braden scores.
A survey was also sent to all disciplines to qualitatively measure the value of the board for physicians, physical therapists, pharmacists, and nutritionists. The survey asked, "In your experience, has information from the facility board directly impacted treatment or plan of care for your patient?"
"We determined that the facility board was impactful," Ms O'Driscoll reported. "We saw a definite improvement at the end of the second month, in all 3 areas." After 2 months of intervention, clinicians intervened for abnormal vital signs in 27% of patients, falls decreased by 33%, and the number of specialty beds ordered (based on Braden score) increased by 32%.
"The increase in the use of specialty beds was ultimately reflected in no pressure ulcers for our inpatient unit," she added.
The survey also showed that 68% of the multidisciplinary team noticed an improvement in interdepartmental communication.
"We kept collecting data for the next 4 months, and we found some great improvements," Ms O'Driscoll continued, with 21% of the unit's patients receiving vital sign interventions, falls decreasing by 50%, and specialty mattress orders increasing by 24%.
Focus on Fall Prevention
"Fall prevention was big," she said. "As charge nurses look at the board, they can see whether the Hendrich score is high, and if so, whether fall precautions are in place," she said. "We saw a big improvement in this area."
The "fall risk bundle" includes a yellow bracelet, yellow nonskid socks, yellow blanket, chair alarm, and yellow star placed outside the room of patients considered at increased risk of falls.
To publicize their successes with the facility board, the nurses published an article in the hospital's newsletter, focusing on the reduction in falls. This brought all stakeholders up to date on the fall risk bundle.
"It was very well received, and we have been able to keep patient falls almost to zero since we started this project," Ms O'Driscoll said.
O'Driscoll J. Utilization of an innovative tool to improve oncology patient outcomes. Presented at: Oncology Nursing Society 41st Annual Congress; April 28-May 1, 2016; San Antonio, TX.