Digital nurse obs system ‘step forward’ in mental health care

Oxford Health Foundation Trust said it had decided to deploy the Digital Care Assistant system developed by technology firm Oxehealth after a trial confirmed it was safe and benefited both patients and staff.

“Nurses have seen this as a way to improve their relationship with patients”

Vanessa Odlin

Using an optical sensor, the software detects and alerts staff to patient movement and can also measure their vital signs.

The trust installed the Digital Care Assistant in six higher acuity bedrooms on a male inpatient ward at Warneford Hospital where nurses would normally check on patients in person every 15 minutes during the night.

It went on to develop a new observation protocol that enables nurses to use the technology alongside their clinical judgment to avoid disrupting patients’ sleep.

Traditional night-time observations require nurses to clearly establish a patient is breathing, which means entering a darkened bedroom and opening blinds or shining a torch.

These safety checks can prevent patients getting a good night’s sleep, which is in turn associated with poorer mental health.

An evaluation of the new system at Oxford Health found the new observation protocol allowed nurses to check on patients at night without waking them up or disturbing their rest.

Between February and April this year, more than 5,000 observations were undertaken over 300 patient nights using the new protocol.

An in-depth evaluation of a sample of 52 observations over six nights confirmed the observations done with the help of the Digital Care Assistant were just as safe as those done without it.

Across the trial there were “no incidents related to the system in any respect”, said the report.

Meanwhile, surveys of patients and staff found the new system was a popular innovation.

Under conventional observation methods, 82% of patients in a snapshot survey said they noticed staff checking on them at night while 73% reported this directly disturbed their sleep.

Under the new protocol 100% of about half a dozen patients said they felt safer and slept better at night while 86% said their privacy had improved.

A snapshot survey of staff found 88% felt they disturbed patients when carrying out traditional observations at night and all felt this had a negative impact on the speed of recovery and wellbeing of people in their care.

“We emphasised that they were not about replacing nursing judgement”

Carol Gee

By using the new protocol all said they felt patient dignity and privacy had improved and 80% felt they were disturbing patients less.

“In addition, all staff surveyed felt that the modified protocol reduced verbal and physical aggression from those in their care,” said the report.

All staff surveyed said they found the adapted protocol easy to use while early findings suggest it also saves nurses a significant amount of time.

A small-scale time and motion analysis was undertaken with of a sample of 10 observation rounds over two night shifts.

“The results indicate that staff can complete observation rounds in approximately half the time using the modified protocol compared to conventional methods,” said the report.

Vanessa Odlin, Oxford Health’s joint service director for Oxfordshire, Bath and North East Somerset, Swindon and Wiltshire mental health, said feedback from those involved in the project had been “astoundingly positive”.

“We have used nursing observations in mental health care for a long time, and we have always had to see patients in person. Now we do not have to do that,” she said.

“Patients have recognised that this is about getting a better night’s sleep and not having nurses disturb them at night by coming into their room or looking through a vision panel in the door,” she added.

“Nurses have seen this as a way to improve their relationship with patients and their experience of the ward. The project has also shown staff that problems can be solved. We can be innovative and use technology to deliver real benefits for patients.”

Carol Gee, modern matron on Vaughan Thomas ward – where the technology was tested – said nurses, patients and families had been consulted before the sensors were installed.

“We emphasised that they were not about replacing nursing judgement, but about giving patients a better night’s sleep and enhancing their privacy and dignity,” she said.

“Using this technology most definitely feels like a step forward,” she added. “The Digital Care Assistant is not intrusive, and it has had a significant impact on patient care, which is what we are all working to improve.

“The sensors free up nurses for other tasks”

Dr Alvaro Barrera

“It lets people have a restful night’s sleep while letting us carry out physical and mental health checks in a more compassionate way.”

Lead researcher Dr Alvaro Barrera, a consultant psychiatrist on Vaughan Thomas ward and Oxford University honorary senior clinical lecturer, described the system as a “real innovation in mental health”.

“While you constantly see developments in physical care a change like this hasn’t been seen in years,” he said.

“The sensors act as a valuable tool to improve patient experience and also free up nurses for other tasks, so they can dedicate more time to patients who need more intensive care.”

The project has been supported by the National Institute for Health Research (NIHR) Oxford Health Biomedical Research Centre and NIHR Collaboration for Leadership in Applied Health Research and Care Oxford.

The trust said further research will be carried out to assess the impact of the Digital Care Assistant on clinical care and nurses’ workload.

Managers said they were hoping to extend use of the technology to the rest of Vaughan Thomas ward and is looking at rolling it out to other wards in the trust.

Oxehealth’s Digital Care Assistants are currently being used by 10 mental health trusts, four care home chains in the UK and Sweden and two police forces.

Nursing Times has previously reported on the introduction of the technology at Coventry and Warwickshire Partnership Trust where it has helped reduce falls on dementia wards and saved nurses a considerable amount of time.