Hill-Rom’s Smart Surface Technology supports patient care quality initiatives and caregiver safety

By, Melissa A. Fitzpatrick, RN, MSN, FAAN

Health care today is undergoing a massive technology revolution driven by a growing need for powerful data to help drive the effectiveness of health care delivery. Evidence-based practice founded on the best science is essential to enhance clinical performance. Innovations ranging from telemedicine and electronic health records to e-prescribing and high-performing “intelligent” or “smart” patient beds are improving clinical outcomes, information flow and operational efficiencies in hospitals nationwide. By integrating real-time data from multiple sources, clinical teams benefit from streamlined workflow with less redundancy, and gain more time to focus on patient-centered care.

With the goal of facilitating clinical technology integration, Hill-Rom, Inc. is a leader in offering data connectivity across its product line of smart bed surfaces. At Hill-Rom, a worldwide manufacturer and provider of medical technologies and related services for the health care industry, we know that the most efficient and safe patient care is comprehensive and integrated, taking into account the needs and challenges faced daily by frontline caregivers.  When used with medical-surgical, bariatric and critical care patients, the smart bed may not only facilitate the redesign of nursing workload to minimize disruptions in patient care, but also it may help to enhance clinical outcomes.

EMR Connectivity That's Smart

Smart bed features are especially important for caregivers as they seek to increase their ability to capture clinically relevant data through interoperability to electronic medical records (EMRs).  A smart bed can communicate to any hospital EMR, nurse call, or other networked patient-care application.  Smart bed technology can enable a reduction in preventable adverse events in hospitals, including patient falls, pressure ulcers and pulmonary complications such as ventilator-associated pneumonia (VAP). This technology also allows caregivers to monitor remotely the head of the bed angle, for example, or bed exit status, and to track the number of times a patient was turned in the last 24-hours to help in the prevention of pressure ulcers.

The smart bed supports the American Recovery and Reinvestment Act criteria for 'meaningful use' and is upgradable.  It also will record data such as a patient's weight and send the information to the EMR or existing hospital network through a wireless or standard 37-pin bed cable. More than 30 clinical data points can be documented electronically besides weight, including head of bed angle, bed exit status, turn assist, and low bed height along with integrated surface information such as continuous lateral rotation therapy (CLRT).* Such applications provide actionable information for nurses and help to enhance not only clinical quality and patient outcomes, but also caregiver safety.

 *The rotation module is present on the TotalCare SpO2RT® Pulmonary Surface.

Transforming Patient Care

We all know that technology alone cannot enhance patient outcomes.  However, when technology is integrated into a clinical setting and used by competent clinicians who consistently apply evidence-based processes supported by best practices, a successful framework is created to enhance outcomes for patients and their caregivers.  By driving interoperability between applications and clinical technology such as smart beds, caregivers will have the ability to decrease workload and time spent on non-value-added tasks while assuring their own safety.  Returning caregiver time to the bedside not only enhances presence and vigilance, but results in safer, more cost effective patient care and a reduction in adverse events.

TotalCare SpO2RT® System Supports Progressive Mobility

Among the fleet of Hill-Rom's smart beds, theTotalCare SpO2RT® critical care bed not only enhances caregiver safety and reduces documentation challenges for nurses, but also supports the practice of improving functional status in the most seriously ill patients.  During prolonged patient immobility in intensive care units (ICUs), adverse effects are seen in the respiratory, cardiovascular, and musculoskeletal systems along with skin breakdown .[i]  Considerable published evidence indicates that these patients have high morbidity and mortality, increased costs-of-care, ^[ii]along with a decline in functional status and quality of life.[iii] Studies tell us that critically-ill patients who begin mobilization early suffer less functional loss and leave ICUs earlier. [iv] 

Implementing a Progressive Mobility protocol based on the patient's individualized assessment and needs helps to reduce the adverse effects of prolonged bed rest.  The protocol is implemented at the patient's current mobility status with a goal of returning him or her to baseline.  It consists of a series of planned, sequential movements such as head elevation, turning, range-of-motion exercises, tilt table, CLRT therapy and progresses to full-chair position, bed egress, and ambulation. [v]  Not only does the TotalCare SpO2RT® System assist with these therapeutic interventions to promote an increase in the functional status of critically ill patients, it also assists the caregiver in electronically capturing and tracking essential clinical data.

Designed to Assist Caregivers

Adherence to turning protocols is monitored and with the weight-based pressure redistribution surface, the TotalCare SpO2RT® system minimizes pressure, shear and friction in patients up to 500 pounds who are at high risk for developing pressure ulcers. The surface also helps manage the microclimate of the skin, controlling heat and humidity, which are vital factors in the prevention and treatment of pressure ulcers.  The FlexAfoot^TM mechanism works to extend and retract a patient's legs for orthostatic training to help stop heel drop as well as patient migration toward the end of the bed.  The surface is embedded with NanoAg+® technology with SmartSilver® ions and provides antimicrobial surface protection to guard against stain and odor causing bacteria.

 Additionally, the TotalCare SpO2RT® surface assures both patient and caregiver safety with its FullChair® feature and chair egress with stand assist features that are available at the touch of a button.  As the nursing workforce ages and as patients get larger, it is essential that caregivers no longer lift patients to facilitate mobility. Using the bed as a chair promotes not only pulmonary function, but also keeps caregivers safer.

As a tool for maintaining VAP protocol compliance, the TotalCare SpO2RT® System has Therapy-On-Demand® modules that offer CLRT along with percussion and vibration therapies. A multidisciplinary, critical care team working in a Georgia hospital conducted a research project initiating CLRT within 24- to 48-hours after pulmonary insult and included intervals of percussion and vibration therapies using TotalCare SpO2RT® surfaces. 

Enhancing Outcomes for Patients and Their Caregivers®

After one year, this team noted an average 33 day decrease in LOS, an average 17 day decrease in ICU LOS, a 16 day decrease in time spent on ventilators, an 8.5 day decrease in total bed days, and a total savings of $2 million.[vi]

For this critical care team, using CLRT therapy and Hill-Rom's leading-edge surface technology contributed to significant improvements in patient outcomes and enabled electronic documentation of the evidence to support clinical decision-making at the point of care.

Combining people, process and technology in this manner is central to our mission at Hill-Rom. Making a measureable difference in patient care is what keeps us searching for innovative solutions such as the TotalCare SpO2RT® surface where the technology and data are within the bed to enable data driven improvements. By automating processes and therapies,  we help to keep patients safe and return caregivers to the bedside so that they can make the greatest difference in patient care.

About the author:

Melissa Fitzpatrick, RN, MSN, FAAN, is the Vice President and Chief Clinical Officer, Hill-Rom, Inc.  Past roles include:  Senior Associate Chief Operating Officer and Chief Nurse Executive at Duke University Medical Center and Vice President of Critical Care and Cardiac Services at Dartmouth-Hitchcock Medical Center.  Fitzpatrick also is a past President of the American Association of Critical-Care Nurses.

References:

[i] Vollman K, Introduction to Progressive Mobility in the Critically Ill, Critical Care Nurse, April 2010, www.ccnonline.org

[ii] Criner GJ, Care of the patient requiring invasive mechanical ventilation, Respiratory and Critical Care Clin. 2002; 8(4):575-592.  

[iii] Douglas SL, Daly BJ, Gordon N, Brennan PF. Survival and quality of life: short-term versus long-term ventilator patients. Critical Care Medicine, 2002;30(12):2655-2662. 

[iv] Morris PE, Holbrook A, Thompson C, Taylor K, Harry B, Ross A, Anderson L, Baker S, Penley L, Sanchez M, Dixon L, Howard A, Passmore L.  Mobility Protocol for Acute Respiratory Failure Patients Delivered by an ICU Mobility Team Shortens Hospital Stay.  Critical Care Medicine, 2007; 34:A20.

[v] Vollman K, Introduction to Progressive Mobility in the Critically Ill, Critical Care Nurse, April 2010, www.ccnonline.org

[vi] Meeks-Sjostrom D, Positive Spin, An ICU's performance improvement project boosts outcomes for pulmonary patients, Advance for Respiratory Care & Sleep Management, 2007; 16 (4):14-15.