JMIR Publications

ABSTRACT

Background:

Technology that detects when a patient at risk for falls is out of bed early can support nurses in acute care hospitals.

Objective:

To develop a better understanding of nurses' perspectives and experiences regarding a bed exit information system (BES) in an acute care hospital setting.

Methods:

BES was implemented in three wards of a university medical center. Nurses completed two surveys at each time point, P0 and P1, using an online questionnaire and participated in focus groups before (P0) and after (P1) implementation. Additional patient information was collected. Descriptive statistics were used to summarize the surveys, and content analysis was used for the focus group data. The respective rates of patients and adverse events in both phases were compared using negative binomial models. Reporting of this study followed the GRAMMS checklist.

Results:

30 questionnaires were completed at P0 (42%) and 24 at P1 (33%). 15 participants completed both questionnaires (complete cases). At P1, 64% of participants agreed that their workload in caring for cognitively impaired patients was reduced by the use of the BES. The adverse event rate per cognitively impaired patient per day was reduced by a factor of 0.613, 95% CI [0.393, 0.955], p=0.0305. In addition, 11 nurses participated in four focus groups before and after the intervention. Participants found it challenging to operationalize the use of the BES due to the heterogeneity of care settings, but certain behaviors of cognitively impaired patients were recognized as indicating a need for intervention. Negative experiences included information overload and alarm fatigue, leading to occasional removal of the system.

Conclusions:

This study highlights the challenges of caring for cognitively impaired patients in acute care hospitals, consistent with existing research. The BES studied proved beneficial in certain situations, but only moderately reduced nurses' workload. To maximize the benefits of BES, an algorithm for its appropriate use should be developed. Future research should include both objective and subjective factors to fully understand their impact on nurses' workload, emphasizing collaboration with nurses in healthcare innovation management. The results of this study may help to better realize the potential of such technologies and improve their implementation. Clinical Trial: The study was registered in the German Register for Clinical Studies (ID: DRKS00021720).