Nothing changes if nothing changes: how an innovative vision-based patient monitoring system helps us to protect our most vulnerable patients from harm
By Matt Butler
Matt Butler is Chief Nursing Information Officer and Clinical Safety Officer at South West London and St George’s NHS Mental Health Trust
When an individual experiences a mental health crisis, being admitted to hospital might be the best way to keep them safe while they receive treatment. But protecting people with serious mental illness from harm, even within the confines of a psychiatric hospital, is a huge challenge both for healthcare workers and the system as a whole.
There are a large number of reasons for this – and many relate to the nature of conditions like depression, schizophrenia and substance use disorders – but staff shortages, extreme workforce pressures, ageing infrastructure and outdated care protocols all play a part.
Reducing restrictive practices
In 2019, NHS England launched the largest safety initiative in the history of the NHS. A key part focuses on improving patient and staff safety in inpatient mental health settings and, in particular, on reducing the use of restrictive practices – something that has been top of the mental health agenda for at least a decade.
Despite this initiative, inappropriate use of restraint and seclusion and the non-adherence to observation protocols still occur, as shown in the recent Panorama and Dispatches programmes. And even when best practice guidance is followed, these interventions can be distressing and dangerous for all those involved.
Stuck between a rock and a hard place
Unfortunately, eliminating restrictive interventions from clinical practice is not always possible. Situations will always arise that, as a last resort, can only be managed by restricting a patient’s rights or freedom of movement through supervised isolation in seclusion, and possibly physical restraint and/or sedation too. When this is the case, the patient will be on eyesight observations at all times and frequent physical health monitoring is absolutely crucial to ensure the patient’s health does not deteriorate.
Health monitoring in seclusion can be really difficult for staff. Patients may refuse to have their vital signs measured and their level of agitation may make it unsafe (for both the patient and staff) for staff to enter the room. Herein lies the dilemma: if we enter the room, patient safety is threatened; if we don’t, patient safety is threatened. So what can be done?
Initiating much needed change
There is no single solution that can remedy the patient safety challenge faced by mental health inpatient services, and some solutions – like investing properly in staff training and recruitment – are long-term oriented. But what can help now is technological innovation designed to target specific problems.
As part of the Global Digital Exemplar programme, South West London and St George’s Mental Health NHS Trust (SWL) implemented a new vision-based monitoring technology (Oxevision) to improve physical health monitoring in seclusion rooms and health-based places of safety.
Oxevision is a contact-free system that enables staff to visually confirm a patient is safe and to measure their pulse and breathing rate remotely. The system also notifies staff when a patient may need help and data can be visualised retrospectively to assist with care planning.
Improving patient safety and promoting person-centred care
On evaluating the Oxevision implementation we found the following clinical quality improvements:
- Breathing and pulse rate measurements post-rapid tranquillisation increased by 36% and 56% respectively
- 96% of surveyed staff said the system helped prevent potential incidents from occurring
- 83% of staff felt they now had better information with which to make care and clinical decisions
All staff said Oxevision helped them to avoid disturbing patients’ sleep (because they could monitor patients’ physical health without entering their rooms) which is likely to have a positive impact on recovery. Interestingly, almost three quarters of staff also said that having the system as part of their clinical practice had improved patients’ therapeutic engagement.
People often fear that technology will compromise the human element of healthcare, but we found the opposite with Oxevision – by making physical health observations in difficult scenarios possible, it freed up time and helped us to deliver care that was more person-centred.
Lessons learnt
Introducing new technologies in healthcare can be daunting and it’s often the responsibility of stretched nursing staff to ensure it’s done safely and effectively. Here are some lessons we learnt from implementing Oxevision at SWL:
- Engage, inform and educate patients and families. And keep doing it
It’s crucial to engage consistently and frequently with patients and carers to ensure they understand what the technology does and why it’s been introduced and feel comfortable with staff using it. This is consistent with the principles of informed consent.
- Develop a continuous improvement plan
Staff require training with clearly defined policies and protocols in place to support new ways of working. It’s also important to create a framework for continuously improving these processes including implementing clinical safety guidance (https://digital.nhs.uk/services/clinical-safety/clinical-risk-management-standards). This could involve working with other organisations to reach a consensus on best practice, as has been done for vision-based patient monitoring systems (see guidelines – including those for seeking consent - from the National Mental Health and Learning Disability Nurse Directors Forum).
- Consider the impact on health inequalities
Be aware of health inequalities when deploying new technologies. These are avoidable, unfair and systematic differences in health between different groups of people, which can either be addressed or amplified when traditional practices are reshaped. It’s helpful to think upfront about your evaluations so that any differences in patient experience and outcomes related to protected characteristics can be identified.
Looking to the future
Compared to general medicine, the field of mental health has seen very few innovation breakthroughs. Patient safety issues can’t be fixed overnight, but technologies like vision-based monitoring systems can help us to maximise the things that go right and minimise the things that go wrong and are therefore a welcome addition to nursing practice.
