Psychiatric inpatients are at high risk for falls and self-harm due to drug side effects and behaviors associated with mental illness. The purpose of the Doctor of Nursing Practice (DNP) Project was to determine if the implementation of ObservSMART, a proximity-based, digital rounding technology, would decrease adverse patient-safety events while reducing falls and providing a reliable tool to assist staff with timely patient observations.

Ultimately, implementing the ObservSMART solution proved to be clinically significant, leading to a decrease in falls and fall-related incidents, while providing an easy-to-use tool for staff to perform critical patient safety checks. The solution also provided measurable staff performance data that highlighted potential areas of improvement.

The Hospital

The setting for the project was a large, freestanding, behavioral health facility in San Diego, CA. that is part of the largest healthcare delivery system in that region. The facility has several units and provides psychiatric services for patients of all ages. Programming covers all psychiatric diagnoses including substance abuse, depression, schizophrenia, Alzheimer’s and dementia. The unit staff are Registered Nurses (RN), Licensed Vocational Nurses (LVN), Licensed Psychiatric Technicians (LPT), and Mental Health Associates (MHA).

The Challenge: Preventing Patient Falls & Self-Harm Incidents

Hospital falls and suicide prevention are Joint Commission National Patient Safety Goals and considered ‘never events’ for CMS. Rapid recognition and preventable intervention for these patients is critical.

The hospital averaged a 4.46 fall rate per 1,000 patient days with a 31% injury rate, and three reported self-harm incidents in the six months preceding the intervention.

Why the Hospital Chose ObservSMART

After a sentinel event occurred and subsequent review of the event, the leadership team concluded that current paper processes, non-proximity based electronic rounding boards and hall cameras did not provide validation that staff were in proximity to patients.

Additionally, it was determined that paper and cameras were retrospective and provide no ability to alert or rectify a missed round. The Chief Nursing Office (CNO) tasked the Manager of Clinical Informatics to research available technologies that would ensure staff and patient proximity during observations to improve patient safety. Research on a total of six products was performed and a comparison grid was presented to the hospital’s CNO and the Senior Vice President of Patient Care for funding approval.   

The ObservSMART technology uses highly tamper-resistant patient Bluetooth wristbands that sync with the observer’s tablet to guarantee staff-to-patient proximity. The system also provides alerts when there are breakdowns in workflow, ensuring patient safety and staff accountability proactively.

When observations are on time and validated, patients are certifiably receiving the proper engagement and care. The other products that were identified during the technology search identified when staff entered a room or where a patient was located, but there was no assurance that staff were within the required proximity of the patient at the time of the observation.

ObservSMART Support

The hospital database was used to review adverse events for six months before and after the implementation of ObservSMART. All inpatients who had either falls or self-harm incidents were included.

Post-implementation daily, weekly, and monthly reports were run from the ObservSMART application. Data on hospital, unit, shift, and individual staff performance was compared to the benchmarks established for banding, on-time compliance, and missed observations.

The ObservSMART’ Customer Success team held weekly meetings to share additional data, highlighting opportunities for staff recognition — and tips and tricks for staff who showed trends of non-compliance. The deeper dive into the data proved helpful to leaders, and they were able to hold staff accountable to ensure improved patient safety.

Fall Incidents & Related Injuries

The implementation of ObservSMART correlated with an initial increase in observed falls due to the enforced accountability. The proximity-based observations helped to identify patients at risk of falls quicker, allowing for appropriate preventative measures to be put in place, and observations be increased as needed.

Timeframe Number of Fall-Related Injuries % Including Minor Injuries % Including Moderate to Major Injuries
Pre-Implementation: January 2019 – June 2019 85 27% 4%
Post-Implementation: August 2019 – January 2020 78 25% 5%

Patient Adoption and Validated Staff Compliance

The initial wearable banding goal was to have 90% of the patients on the seven inpatient units. Immediately post-implementation in August 2019, banding percentage was 93%. Since implementation the banding goal has steadily been increased to the current goal of 98%.

Staff compliance was measured by the performance of observations within the timeframes determined by hospital guidelines. Locked units must perform observations every 15 minutes. Unlocked units must perform observations every 30 minutes or every 60 minutes. The initial benchmark for validated observation compliance was 98% for the hospital and has since moved to 100%.

The Results

The goal of the project was to determine if implementing ObservSMART would decrease adverse patient safety events, particularly falls and self-harm. During the 6-month period the staff performed over 2.8 million validated observations. The results proved that the hospital demonstrated a 20% decrease in falls within 6 months of implementation.

The unlocked units had the highest monthly fall rate pre- implementation. The implementation of ObservSMART drove a 27% decrease in falls and an 8% decrease in fall-related injuries, thus reaching the established project goals to promote intentional, validated rounding and improve patient safety.  ObservSMART was proven to provide an additional level of safety for both patients and medical staff members in inpatient care scenarios.

Its proximity-based system ensures that patients are observed at the required interval and appropriate distance, meeting the standard of care for high-risk, or vulnerable patients. Contact us to learn how your behavioral health facility can achieve validated compliance on your patient safety checks.