Research Project on Telesitter Systems

Anonymous

Question Description

Please use data to complete chapter 4 and 5, and then put together all chapters 1 to 5 together. please be sure with correct APA formatting and citation. please feel free to ask for clarification

Tutor Answer

Proff_White
School: UC Berkeley

Attached.

Assessing the Effectiveness of Telesitter Systems in Reducing Patient Falls
Submitted by
Njideka Laura Akubuilo

Direct Practice Improvement Project Proposal
Doctor of Nursing Practice

Grand Canyon University
Phoenix, Arizona
September 19, 2018

Chapter 5: Summary, Conclusions, and Recommendations

A. Introduction


This chapter mainly presents concluding remarks concerning the findings
from this project.



The major findings from this project are the factors causing falls in the used
healthcare units despite the use of the Telesitter monitoring system.



Based on the identified factors, the DNP student in collaboration with the
participating nurses ventured on finding the solutions to the challenges.



The incident reports were the major source of the data findings.



This project entailed collecting the factors leading to falls as well as the
identified possible solutions to the fall factors.



The factors causing falls were categorized into six main sections – physical,
environmental, psychological, Telesitter-related, caregiver related, and videooperator related factors.



The project mainly focused on two units in the Southern California Hospital
for data collection – the surgical/oncology unit and the progressive care unit.



The incident reports were mainly collected for the project period of one
month.

B. Summary of the Project


The project’s main aim was to find out the factors causing falls in the
selected wards despite the use of the Telesitter system as a falls reduction
tool.



The project entailed using the surgical/oncology and progressive units to
determine the major factors leading to falls when using the Telesitter
systems to monitor patients.



This project focused on answering two main questions:
i. What are the challenges associated with using the Telesitter
monitoring system as a falls reduction intervention?
ii. What solutions can be implemented to avoid these challenges and
make the Telesitter systems more reliable and effective as a falls
reduction tool?


The major statistical analyses used include excel statistical graphs,
descriptive statistics, and the independent sample t-test.

C. Summary of Findings and Conclusion


The major finding from this this project is that the Telesitter system is
faced with many challenges when used as a falls reduction tool.



This project identified that factors causing falls can be classified into sic
categories including physical factors, environmental factors, psychological
factors, Telesitter related factors, video operator factors, and caregiver
related factors.



The major conclusion from this project is that the exclusive use of the
Telesitter monitoring system as a falls reduction intervention does not offer
significant results in reducing falls.



This project proposes the combination of the Telesitter systems with yet
another technological tool – the Fallarm device, which is expected to help

in reducing the incidences that lead to falls.


It is expected that fixing all the identified challenges will help in improving
the Telesitter system to make it a reliable tool in the reduction of falls.

D. Implications


In this case, this project proposes the adoption of the Fallarm device as an
additional technological intervention. It is expected that combining the
functionality of the Telesitter systems and the Fallarm device will help to
reduce patient falls in the clinical setup.



Another core implication from this project is that caregivers should put
more emphasis on monitoring and observing the high fall-risk patients.



Another possible implication resulting from the findings of this project is
that the Telesitter system needs redesign as well as changing some of the
working mechanisms such that it promotes a quiet and calm environment,
conducive for patients’ healing and relaxation.



One of the strengths of this project is that it uses a small sample size of
only 60 nurses, which guarantees lower errors during data collection and
project implementation.



One downside of this project is the small sample size.



The conclusions made from this project are very credible considering that
the data collection tool – the Electronic Health Records, has a high validity
rating of 100% for recording falls and personal opinion, as is the case for
this project.

I.

Theoretical implications.


The findings from this project indicate that the use of the Nightingale
environmental theory of nursing as well as the Newman’s theory of health as
expanding consciousness is vital in the clinical setup.



The theories also present that engaging the patient from time to time could
also help them to remain conscious and adaptive to the healing process.



Attaining a state of tranquility among patients is a key endeavor in working
against psychological factors leading to falls.

II.

Practical implications.


The first practical implication from this project is that there is need to
redesign the Telesitter systems such that design elements that could be
leading to falls as identified by the incident reports need to be changed.



Apart from that, another implication arising from the project findings is
that the patient’s environment should be improved and organized in an
appealing manner to help and restore cognitive as well as psychological
calm in patients.



It is thus recommended that the Telesitter monitoring system be used in
combination with another falls reduction intervention to ensure that it is
effective in reducing falls.



Another core insight it is that the best approach in effectively addressing
the issue of patient falls is the use of a multi-interventional approach.

III.

Future implications.


The main futuristic implication the findings from this project present is that

there is need to design an improved Telesitter system that will also integrate
with the Fallarm device such that the communication channels of the system
will be placed on the Fallarm device whereas the video functionality will
remain with the Telesitter.

E. Recommendations


The main recommendation from the project findings is that patient falls
reduction interventions should always take the multi-interventional
approach.



Another major recommendation in this project is that there is need to
beautify the patient’s environment. This recommendation is grounded in the
principles of the two theoretical frameworks used in this project including
the Nightingale’s environmental theory of nursing and the Newman’s theory
of health as expanding consciousness.



Another recommendation is changing the design aspects of the Telesitter
systems so that the communication module is added to the Fallarm device.



Apart from the above, it is also recommended that a stable change
management model be used to change how the Telesitter system is used.
Kotter’s eight step change management tool can help to adapt caregivers to
the redesigned Telesitter systems.

I.

Recommendations for future projects.


For future projects, it is recommended that researchers embark on
conducting the same study in multi-settings, as well as include many

participants. This will help in ascertaining whether the research findings
correlate to the findings in this project.


Another recommendation for future research is to find out whether there are
other cost-effective methods of reducing patient falls that can be used in
combination with Telesitter systems.

II.

Recommendations for practice.


There is need to adhere to Kotter’s eight-step change management tool to
ensure that the change process is done successfully.



It is also recommended that policies be implemented to ensure that only the
multi-interventional approach is used in preventing falls.

Attached.

Assessing the Effectiveness of Telesitter Systems in Reducing Patient Falls
Submitted by
Njideka Laura Akubuilo

Direct Practice Improvement Project Proposal
Doctor of Nursing Practice

Grand Canyon University
Phoenix, Arizona
September 19, 2018

ii
GRAND CANYON UNIVERSITY

Assessing the Effectiveness of Telesitter Systems in Reducing Patient Falls
Submitted by
Njideka Laura Akubuilo

has been approved

December 31, 2018

APPROVED:
Full Legal Name, Ed.D., DBA, or Ph.D., DPI Project Chairperson
Full Legal Name, Ed.D., DBA, or Ph.D., Committee Member
Full Legal Name, Ed.D., DBA, or Ph.D., Committee Member

ACCEPTED AND SIGNED:
________________________________________
Lisa Smith, PhD, RN, CNE
Dean and Professor, College of Nursing and Health Care Professions
_________________________________________
Date

Revised 10/26/2018 DNP Team (Learner: Please remove this footer)

iii
Abstract
Patient falls remains as one of the major challenges to the healthcare sector. Patient
falls has many negative consequences on the patient as well as the health institution.
Patients endure extended hospital stays, head injuries, broken limbs, increased pain and
suffering, and many other problems. This therefore necessitates that new and better
interventions be coined to help in reducing the rate of patient falls. This project focusses
on understanding the effectiveness of Telesitter systems, identifying the challenges
associated with the Telesitter monitoring systems, as well as identifying the solutions to
the identified problems. This project uses the Nightingale environmental theory of nursing
and Newman’s theory of health as expanding consciousness. The findings from this project
indicate that combining the use of Telesitter systems and Fallarm tactile sensor wearable
device can help to enhance the effectiveness of Telesitter systems as a falls reduction
intervention. The Fallarm device helps by sounding an alert whenever the fall risk of the
patient is escalated. This intervention will ensure that patients with high fall risk probability
are closely monitored through the Telesitter monitoring system as well as the tactile sensor
device, ensuring that their probability of falls is greatly reduced. This recommendation is
also in line with Johnson (2014), whose research found out that the best approach to solve
patient falls is using multi-interventional approach. Implementing the two technological
interventions in the healthcare system is deemed to have invaluable benefits in reducing
falls rate as well as boosting quality of care.

Keywords: Patient falls, Fallarm, Telesitter monitoring systems, fall prevention,
acute care, and fall risk.

Revised 10/26/2018 DNP Team (Learner: Please remove this footer)

Dedication
I dedicate this project to all patients receiving care in the critical care unit,
progressive care unit, and the oncology unit. They are more prone to falls and I am
confident that the findings from this project will help to reduce fall risk. I am sure that
successful implementation of the proposals in this project will help in catering for the
needs of the targeted patient population, thus reducing falls as much as possible.

v

Acknowledgments
I take this precious opportunity to thank God Almighty for his infinite mercy and strength
He gave me throughout this project. I also seize this opportunity to thank my supervisor
and the committee team for their dedication and support, and immense contribution
academically in approving this project. They have helped me shape this project into a
professional scholarly project and I am confident that it will help to transform healthcare
delivery in the acute care setting. I also thank my parents for their contributions
spiritually, morally, and financially. I also thank my siblings and friends for their spiritual
and moral support during the entire time of the project; I appreciate all of you. God Bless
you all.

vi

Table of Contents
List of Tables .......................................................................................................................x
List of Figures .................................................................................................................... xi
Chapter 1: Introduction to the Project ..................................................................................1
Introduction ....................................................................................................................1
Background of the Project .............................................................................................4
Problem Statement .........................................................................................................5
Purpose of the Project ....................................................................................................7
Clinical Question ...........................................................................................................8
Advancing Scientific Knowledge ................................................................................10
Significance of the Project ...........................................................................................12
Rationale for Methodology ..........................................................................................14
Nature of the Project Design ........................................................................................15
Definition of Terms......................................................................................................16
o

Telesitter ...............................................................................................16

o

Patient-falls ...........................................................................................16

o

Caregiver ..............................................................................................16

o

Impromptu patient calls ........................................................................16

o

Impromptu caregiver calls ....................................................................16

o

Elderly patients .....................................................................................16

o

Panic .....................................................................................................17

vii

o

Anxiety .................................................................................................17

o

Fear .......................................................................................................17

o

Fall rate .................................................................................................17

o

Fallarm device ......................................................................................17

Assumptions, Limitations, Delimitations ....................................................................18
Summary and Organization of the Remainder of the Project ......................................19
Chapter 2: Literature Review .............................................................................................22
Introduction to the Chapter and Background to the Problem ......................................22
Theoretical Foundations and/or Conceptual Framework .............................................26
Review of the Literature ..............................................................................................28
Falls and their effects on patients and hospitals.............................................28
Factors related to falls. ...................................................................................32
Fall prevention interventions including Telesitter type systems, Fallarm
wearable devices, and fall risk assessments. ..............................................................37
Literature findings on the variables. ..............................................................41
Summary ......................................................................................................................44
Chapter 3: Methodology ....................................................................................................47
Introduction ..................................................................................................................47
Statement of the Problem .............................................................................................49
Clinical Question .........................................................................................................51
Project Methodology....................................................................................................52

viii

Project Design ..............................................................................................................53
Population and Sample Selection.................................................................................54
Instrumentation of Data ...............................................................................................56
Validity ........................................................................................................................57
Reliability.....................................................................................................................58
Data Collection Procedures..........................................................................................58
Data Analysis Procedures ............................................................................................60
Ethical Considerations .................................................................................................61
Limitations ...................................................................................................................62
Summary ......................................................................................................................63
Chapter 4: Data Analysis and Results ................................................................................65
Introduction ..................................................................................................................65
Descriptive Data...........................................................................................................67
Data Analysis Procedures ............................................................................................68
Results ..........................................................................................................................78
Summary ......................................................................................................................79
Chapter 5: Summary, Conclusions, and Recommendations ..............................................81
Introduction ..................................................................................................................81
Summary of the Project ...............................................................................................82
Summary of Findings and Conclusion .........................................................................83
Implications..................................................................................................................85
Theoretical implications.................................................................................87
Practical implications. ....................................................................................88

ix

Future implications. .......................................................................................89
Recommendations ........................................................................................................89
Recommendations for future projects. ...........................................................91
Recommendations for practice. .....................................................................91

x

List of Tables
Table 1 .............................................................................................................................. 67
Showing demographic characteristics of participants ..................................................... 67
Table 2 .............................................................................................................................. 69
Showing number of patient falls per week in the Surgical/oncology and the Progressive
care units ........................................................................................................................... 69
Table 3 .............................................................................................................................. 70
Showing descriptive information of the causes of falls and the possible solutions to falls
in the progressive and the Surgical/oncology units .......................................................... 70
Table 4 .............................................................................................................................. 73
Summary statistics of the analysis of variables ................................................................ 73
Table 5 .............................................................................................................................. 74
Showing the Regression Analysis ..................................................................................... 74
Table 6 .............................................................................................................................. 75
Showing the Correlation Analysis .................................................................................... 75
Table 7 .............................................................................................................................. 76
Showing the Test-Statistics ............................................................................................... 76

xi

List of Figures
Figure 1 ............................................................................................................................. 70
Comparison of patient falls in the Surgical/oncology and the Progressive care............... 70
units ................................................................................................................................... 70

1

Chapter 1: Introduction to the Project
Introduction
Patient falls in hospitals remain as one of the biggest issues facing the healthcare
sector. It leads to the patient incurring injuries, deaths, extended hospital stays, and
equally high medication costs (Chan, 2015). Although there are many interventions put in
place to help prevent patient falls, it remains one of the most challenging issues in the
healthcare sector, especially in the acute care setting. As such, finding the most reliable
and effective patient-falls prevention method is the key in enhancing the quality of
patient care and patient satisfaction.
This project focuses on identifying the challenges associated with the Telesitter
monitoring technology in preventing patient falls, as well as the possible solutions to
these challenges. The working mechanism of the Telesitter systems is closely related with
that of bed alarms and sensors, and the resultant effect of using the two systems is
expected to be the same, especially concerning their effectiveness (Shorr et al., 2013).
This exposes the Telesitter systems to the same challenges posed by the bed alarms. One
such instance is when the video observer in the Telesitter systems abruptly starts
conversation with a specific patient, which can cause panic and disturbance among
patients. This scenario can cause the Telesitter system to be associated with many
downsides that can enhance the rate of patient falls rather than help in preventing patient
falls (El-Khoury, Cassou, Charles, & Dargent-Molina, 2013). This project will use six
categories to identify the possible causative agents of the falls. The main categories of
factors include the physical factors, environmental factors, psychological factors

V.1.2 5.24.15

2

(Delahoz & Labrador, 2014), video operator factors, Telesitter system factors, and the
caregiver factors.
In order to enhance the effectiveness of this phenomenal and important tool in the
healthcare sector, this research will find possible solutions to the identified challenges.
Apart from that, the use of the Fallarm equipment alongside the Telesitter system is
encouraged for the high fall-risk patients (Davis, Kutash & Whyte, 2017). Delahoz &
Labrador (2014) present the Fallarm equipment as a reliable tool that can help in reducing
falls. The tool has capability to detect the position of the patient and consequently warn
them whenever their position indicates that they have high fall risk. The system issues a
warning sound, as well as warning lights to indicate whether a patient is in good position
or is faced with high fall risk.
The Fallarm device is beneficial because it will help in detecting high fall risk
situations and alerts the patient as well as the caregivers. Fallarm is a small wearable
wrist device that can detect patient movements and positions, and warn the patient
whenever the fall-risk rises (Delahoz & Labrador, 2014). The device has mini speakers
where the patient can communicate with a caregiver: it also has a visual feedback
component: and tactile feedback component (Davis, Kutash & Whyte, 2017). The device
uses inertial sensor to detect the position and movements of the patient. The device warns
the patient of high fall-risk by flaring a light alert. The lighting system gives red, amber,
and green to indicate high fall risk, medium fall risk, and low fall risk respectively. The
device also has a tactile system that uses pager motor to tap the user consistently
whenever their fall risk levels rise (Davis, Kutash & Whyte, 2017). The system also
notifies the caregiver whenever a patient’s movements or position translates to high fall
V.1.2 5.24.15

3

risk. This enables the caregivers to attend to patients that need immediate attention, thus
helping to reduce falls.
Although studies have in the past focused on the benefits of the Telesitter
technology in preventing patient falls, no research study has yet ventured in finding out
the disadvantages of using this technology in the acute care setting (McCurley & Pittman,
2014). In light of this, this project will be unique and beneficial in the healthcare sector
because it will help to fix the challenges associated with the Telesitter monitoring
systems, helping this phenomenal tool to further reduce the rate of falls when used as a
falls reduction intervention. According to Davis, Kutash & Whyte (2017), the use of
Telesitter monitoring systems as opposed to in-room sitters helped to reduce fall rate by
6%. Considering the technological advantage of Telesitters, this reduction rate is small
and there is need to fix the possible challenges associated with the tool to ensure that it
has higher capability of reducing falls significantly. Fixing these challenges, as well as
combining with the use of Fallarm devices among the high fall risk patients is deemed to
offer a better solution to the challenge of patient falls in the healthcare sector (Delahoz &
Labrador, 2014).
This project will use the surgical/oncology and the progressive care units at the
Southern California hospital as the main source of participants. Although the Telesitter
systems are currently being used in these units to monitor patients, there is still high rate
of falls. This project is set to find out the challenges leading to the falls and the solutions
as outlined in the various incident and falls reports.

V.1.2 5.24.15

4

Background of the Project
Patient falls, especially in the acute care setting, have been a long time problem in
the healthcare sector. Although many solutions have been adopted to prevent patient falls,
the incidence of patient falls across the United States has remained alarmingly high.
Currently, at least 700,000 to 1 million patients exhibit falls in the healthcare setting each
year (AvaSys, 2014). Among those who experience falls, at least 30% and above exhibit
serious injuries that result in extended hospital stay or even death due to head injuries
(Pearson & Coburn, 2011). On average, each single patient fall costs the healthcare
system and the patients an extra $14,000 (AvaSys, 2014). In 2008, the Centers for
Medicare & Medicaid Services classified patient falls as a hospital-acquired condition
and withdrew compensation for the complications that ensued (AvaSys, 2014).
Considering that the costs associated with patient falls are not payable by Medicaid and
other third party payers, it is important that better patient fall prevention strategies be
implemented to help in reducing the additional falls-related cost burden on healthcare
institutions.
A new milestone in the healthcare sector occurred in 2008 when the AvaSure
Corporation developed the AvaSys Telesitter systems as a technological solution to the
problem of patient falls (AvaSure Holdings, 2015). Although this system is effective, it
does not offer the best solution to the issue of patient falls. The main downside of this
technological tool is its impromptu mode of operation where the video controller or a
patient abruptly initiates communication through the device. This is mainly associated
with disturbances to the other patients in the ward, who require calm environments to
enhance their rest. The impromptu blaring of sound from the video operator through the
V.1.2 5.24.15

5

system or from a patient to the video operator can cause disturbance to resting patients,
which can then induce panic, anxiety, and fear among patients, leading to more falls. To
the nurses, the impromptu mode of operation of the Telesitter systems can cause panic,
anxiety, and nervousness among nurses, which can lead to more accidents and errors. The
reliance on calls from the video operator can also lead to non-observance of the other
patients. This is because the nurses will rely more on the video operator, which can derail
their attention from the other patients who do not show physical signs of suffering and
pain. Reliance on the video operators is also not an effective approach because the mode
of operation of the Telesitter systems would fail when the video operator falls asleep or is
not attentive in monitoring the patients. This challenge gives chance to the idea of
combining Telesitter systems with Fallarm devices (Delahoz & Labrador, 2014). This
project will also set out to find possible solutions to all other challenges associated with
using the Telesitter systems as a falls reduction tool.
Problem Statement
The main problem of focus for this project is the continued incidence of patient
falls even after the implementation of the Telesitter monitoring systems as a falls
reduction strategy. This project is set to find the factors leading to falls despite the use of
the Telesitter systems in wards. The project will also venture into finding the possible
solutions to the challenges associated with using Telesitter systems as a falls reduction
strategy. Telesitter systems are a technological tool, and one that offers better prospects
to the clinical sector when focusing on patient monitoring and surveillance. The system
was specifically designed as a falls prevention system, but has fallen below expectations
in the recent years since patient falls are still on the rise (CDC, n.d.). Finding and fixing
V.1.2 5.24.15

6

the challenges associated with the Telesitter systems is vital in enhancing the fight
against patient falls.
The population affected by the problem of falls is predominantly elderly
individuals aged 65 and over, but even younger individuals can develop healthcare
complications that need surgery and chemotherapy and can be equally be affected by
falls. This project is targeting to identify the factors leading to falls in the
surgical/oncology unit and the progressive care unit at Southern California Hospital. The
categorization and prioritization of these factors in regard to their manifestation will then
guide the DNP student to select the best solutions. Implementing these solutions is
deemed the best possible intervention in ensuring that the Telesitter is an effective tool in
reducing the rate of patient falls.
This project will contribute to the literature by outlining the challenges associated
with the Telesitter systems, and equally offering possible lasting solutions to these
challenges. It is not known whether the use of the Telesitter system could be causing
panic, anxiety, and fear among patients and caregivers, which could lead to more falls,
accidents, and errors in the healthcare setting. This is because the system works using
observation, which has the assumption that patients that appear to be still and relaxed
during observation are doing fine, but this assumption might be wrong in most cases.
There is need to find out if the use of the Telesitter system decreases caregivers’
vigilance and alertness in providing care to patients. Identifying the challenges associated
with the Telesitter system when used as a falls reduction tool will help to implement
corrective measures. There is also an importance to investigate if the Telesitter systems
are a contributory factor to some of the falls. These factors will be measured through
V.1.2 5.24.15

7

evaluation of participants’ perception about the challenges associated with the Telesitter.
The Telesitter system is particularly of focus because it is technological, but its mode of
operation is similar to that of bed alarms and sensors, which in the past have been
associated with many challenges to both the patients, as well as the caregiver. As such,
the project will help in identifying the most effective solutions to the challenges
associated with Telesitter systems, and thus improve its effectiveness in preventing
patient falls.
Purpose of the Project
The purpose of this quantitative exploratory-descriptive research is to identify the
challenges associated with using the Telesitter monitoring systems in the clinical setting,
as well as finding lasting solutions to these challenges to ensure that the Telesitter system
is a reliable tool in the reduction of patient falls. This project will assess and evaluate the
causes of patient falls in the two wards – surgical/oncology and the progressive care
units, at Southern California Hospital. Using the two units will help to identify the most
recurrent fall risk factors in these wards. This will offer a more comprehensive list of the
factors leading to falls despite the use of the Telesitter systems. Identifying the factors
causing falls in the two units will help to identify the most-recurring factors, which will
point out to the best possible solutions to these challenges.
This project is set to determine the effectiveness of the Telesitter systems in
preventing patient falls, as well as the possible challenges facing this falls-prevention
intervention. The findings from this project will guide in understanding the challenges
associated with the Telesitter systems and how best these challenges can be addressed to
ensure that it is a more effective tool in reducing patient falls. The Telesitter system is a
V.1.2 5.24.15

8

phenomenal intervention in the fight against patient falls, ironing out its associated
challenges will present a more reliable and effective tool in reducing patient falls.

Clinical Question
The major clinical questions that will guide this project include:
Question 1: What are the challenges associated with using the Telesitter monitoring
system as a falls reduction intervention?
Question 2: What possible solutions can be implemented to solve these challenges and
make the Telesitter systems more reliable and effective as a falls reduction tool?
The first clinical question will help in understanding the challenges associated
with the Telesitter monitoring systems whereas the second question will help in
understanding how the...

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