Oxford Health NHS Foundation Trust has introduced a new observation protocol for checking the safety of patients with severe mental health conditions at night, following a formal evaluation of technology from Oxehealth.
Nurses no longer have to disturb patients up to four times an hour at night if they are being cared for in rooms with the Oxehealth Digital Care Assistant (DCA). The equipment uses an optical sensor to detect movement, pulse and breathing rate.
In a change to long-standing national practice, nurses on the Vaughan Thomas Ward, a male acute inpatient ward at the Warneford Hospital, now use the DCA in some rooms to quickly and safely observe movement and measure vital signs. Patients get a better night’s sleep and benefit from more privacy and dignity.
A better night’s sleep
Vanessa Odlin, Oxford Health’s joint service director for Oxfordshire, BaNES, Swindon and Wiltshire mental health, said, “We have had astoundingly positive feedback."
"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 rooms or looking through a vision panel in the door.
“And nurses see it 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 and that we can be innovative and use technology to deliver real benefits for patients.”
Identifying the importance of sleep to recovery
Oxford Health started working with Oxehealth after Dr Alvaro Barrera, a consultant psychiatrist at the trust, led a study on the importance of sleep to recovery on Vaughan Thomas ward in 2016.
The study was backed by the Health Foundation and supported by the National Institute for Health Research (NIHR), Oxford Health BRC and NIHR CLAHRC.
In 2018, the trust installed the DCA in six of the 18 patient bedrooms - on Vaughan Thomas ward. The rooms were chosen because they are used by the most-severely-unwell patients who may need to be observed every 15 minutes.
After careful evaluation, the new observation protocol was introduced in February 2019 and a service improvement evaluation was carried out to study its impact.
The evaluation revealed that staff can confirm patient safety without disturbing or waking resting patients at night.
Between February and April 2019, more than 5,000 observations were taken over 300 patient nights using the new protocol.
And an indepth evaluation of 52 observations taken over six patient nights confirmed the observations taken with support of the DCA were just as safe as those taken without it; and there have been no incidents related to the system.
Professor John Geddes, director of research and development at the trust and head of department of psychiatry at Oxford University, said: “The modified protocol greatly improves patients’ experience at night. 86% of patients questioned felt their privacy had improved at night, and 100% said they ‘felt safer’ and ‘slept better’."
Carol Gee, the modern matron on Vaughan Thomas ward, said: “We engaged with the nursing team, patients and their families 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.
“Using this technology definitely feels like a step forward. The DCA is not intrusive and it has had a significant impact on patient care, which is what we are all working to improve.
“It lets people have a restful night’s sleep, while letting us carry out physical and mental health checks in a more-compassionate way.”
Time to care
Dr Alvaro Barrera, a consultant psychiatrist on Vaughan Thomas ward and Oxford University honorary senior clinical lecturer, who is the lead researcher on the project, added: “You rarely see such innovation in mental healthcare. “The sensors free up nurses for other tasks so they can dedicate more time to patients who need more-intensive care.”
Further work will now be undertaken on this finding and on the clinical impact of the DCA.
Hugh Lloyd-Jukes, chief executive of Oxehealth, points out that the Oxehealth’s Digital Care Assistant generates vital, previously-unavailable data.
He said, “We will be working with many other trusts who are already moving in the same direction, with 19% of all the mental health trusts in England choosing to support their brilliant staff with these unique clinically-validated digital teammates."