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Video Surveillance to Reduce Falls and Monitor Seizure Patients: A

Quality Improvement Proposal.

Name: Stellah Batir

Course: NSG 460

James Madison University

Instructor: Janice Gandy

April 25th, 2021

Video Surveillance to Reduce Falls and Monitor Seizure Patients: A

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Quality Improvement Proposal

According to the Center for Disease Control and prevention, CDC (2020) each year about

$50 billion is spent on medical costs related to non-fatal fall injuries and $754 million is spent

related to fatal falls. Clearly, fall prevention should be a priority in the health care industry,

especially the hospitals. Many patients fall in hospitals every year and between 30 to 35 percent

of patients who fall sustain an injury. The approximated average cost for a fall with injury is

about $14,056 (Joint Commission Center for Transforming Healthcare, 2021). They can often

lead to death, physical and psychosocial trauma like reduce mobility and loss of independence

(CDC,2020). To prevent falls the hospital often finds a sitter as a fall prevention strategy who are

often expensive. If multiple patients are fall risks, then more sitters are hired driving the cost up.

Video monitoring has slowly evolved, and it is becoming an option for fall prevention

since it can use one tele sitter to watch multiple patients. Research shows video monitoring has

been available since 2012 but few hospitals and organizations have installed it. This proposal

will advocate for the use of video monitoring due to its potential in cost savings and safety

enhancement. Due to physical sitters being expensive, remote video monitoring is becoming an

option to reduce falls because it allows one tele sitter to watch and redirect more than one patient

which saves time and money (Davis & Carter-Templeton, 2020). This paper will discuss and

evaluate the effectiveness of video monitoring on fall prevention and seizure prevention while

also discussing the positive impact on safety and quality.

PICO: In fall risk patients in a hospital setting does the use of video surveillance systems

such as tele sitting promote safety by reducing number of falls and monitoring seizure activity in

the medical surgical unit?

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Background

This paper will address video surveillance also known as video monitoring and its

importance as a quality change agent in promoting patient safety. In the hospitals patient are

influenced by various factors such as the need to toilet, pain, medication, or the disease process

such as strokes that causes impulsiveness. According to Davis & Carter-Templeton (2020),73%

of patients fall within the first year after a stroke. Hospitals should therefore use strategies to

prevent falls. When patients fall, they stay at hospital longer and also hinder healing which in

turn drives the cost for the patient and hospital higher (Davis & Carter-Templeton, 2020). This

QI will be reviewed and approved by the hospital review board. The purpose of this quality

improvement proposal is to ensure patient safety is established through video monitoring of fall

risk and seizure patients in a hospital setting. Literature review will also be used to support the

use of video surveillance.

The purpose of this study is to propose a quality improvement tool that will improve

patient safety in terms of fall reduction and monitoring of seizure patients with the objective of

standardizing the monitoring through the medical surgical unit. Before the video monitoring is

implement, a written consent will be obtained from family or patient for the participation of the

study. The research question posed above will be utilized to find out whether video monitoring

reduces falls and monitors seizures effectively.

How Video Surveillance works.

According to Cournan et al. (2018) video monitoring is defined as the use of portable

camera that are installed in a patient’s room with speakers or amplifiers as a trained technician

directly observes patients in their room from a secluded or remote site. It works when the

microphone can pick up sound from the room from all directions in the room. Cournan et al.
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(2018) further suggest that high quality cameras should be used in order to prevent any possible

obstacle. The lighting should also be considered for excellent picture. Another important thing to

note suggested by Hamandi et al. (2017), is that the cameras must show the patient in full focus

which in turn ensures that the patient is monitored every minute to prevent falls. After the

cameras have been set up and installed the technician or tele sitter will be able to talk to the

patient and/or contact staff members to respond to the room, preventing a fall (Cournan et al.,

2018).

Methods

Ensuring falls are prevented will improve safety and quality of the overall hospital and

ultimately save money. This QI proposal will utilize the plan, do, study and act (PDSA) model

that uses four cycles as a study model. In the Plan section of this model, a team of technological

support will be chosen and will be responsible to map the whole implementation of the QI

process. Seven video monitoring cameras and audio will be installed in designated rooms at the

hospital. Tele sitters will be able to use the nurse call system to alert responsible parties. The

number of falls will then be tracked and recorded for data analysis.

This will lead to the next step important section which is the Do portion. This step is the

actual implementation of the proposal. Ensuring that the project works going live is advised so

that observations and data are collected that will help enhance the transition. Nurses will be

encouraged to use the system and report on the outcome. Recommended modifications and use

of the monitoring procedure will be executed in every PDSA cycle. The third step is the Study

section in the PDSA phase will show data results after a minimum of 4 study cycles of using

video monitoring patients. Here is where success, failures or suggestions are discovered thus
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analysis of the results will help in future improvements. New ideas can be proposed so feedback

is encouraged from the whole health personnel.

Finally, the Act section of the cycle which is the main purpose for this QI proposal is to

ensure that falls are reduced, and supervision of seizure activities is done. Reporting of results is

expected in this stage and project results analyzed to promote and improve user feedback.

HIPPA CONCERNS

Privacy and limitations

HIPPA states, nurses must understand the right to confidentiality and that unauthorized

use of information or photographs makes one liable for invasion of privacy or defamation. We

should be aware not to disclose information in public places or even take pictures and or screen

shots in order to avoid violations or put oneself and others at risk for disciplinary action. It is of

utmost importance to understand that is that the privacy rule is that it guarantees that the patient

information will be protected and can only be disclosed by permission of the patient.

Protocols

Having a hospital protocol that states the statues of limitations and proper use of the

video surveillance is important because nurses can use it as a tool of reference.

Video Surveillance Industry

Barriers and challenges of video surveillance included are technological difficulties and

lack of manpower. Other challenges also include the fact that strong internet availability is

needed that will not freeze videos because patients have to be monitored every second around the

clock.

Technology & Technology support

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As discussed previously a video technician or tele sitter will use live video feeds and a

two-way audio radio to interaction with the patient when they notice observing potentially fall

risk behaviors or seizure activities. With Connectivity issues ensuring that a good internet

connection company is used is vital to the success of this QI project. The current provider will be

notified of the intended changes and a back up plan put in place to prevent any lapse in time

during video monitoring of patients.

Use of Tele Sitters

Nurse call system is a monitoring system that will connect nurses to their patients at all

times. When a patient tries to get up or has a witnessed seizure then the technician or tele sitter

alerts the nurse. The tele sitter will be responsible to let the nurse know if the patient is at risk.

Satisfaction and Compliance will also be measured yearly by determining the number of falls in

the year the QI was implemented to the years previously.

Effectiveness of Video Surveillance

Patient Safety is important and is the basis of this quality improvement proposal. The use

of video surveillance in the hospital in order to reduce falls and monitor seizure patients in the

unit is effective. During the monitoring tele sitters will record activities of patients being

monitored and include vital information like admission dates and why they were being

monitored. Sitters also recorded any intervention such as redirecting using a microphone or

though nurse call.

This will in turn decrease physical sitters and overall costs reduction of falls.

Improvement on feedback

Data analysis to measure effectiveness will be collected during and after the video

surveillance has been installed needs to be added in order to compare the cost of falls and cost of
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sitters. Baseline data will be collected before the initial surveillance over a period of one year.

The data will be analyzed by analyst using simple descriptive numbers and statistics to reveal the

impact of video surveillance.

Conclusion

Finally, video monitoring will boost quality improvement and create a smooth transition

that will allow for a safety improvement. This responsive change will ultimately ensure that

quality improvement is promoted. When the video monitoring systems are installed and in use

then the rate of falls is expected to reduce compared to not having video surveillance. As stated

in the in the introduction of this proposal the cost of falls is very high and if surveillance is

implemented then patient quality and safety will be improved. This QI project emphasized on the

use of video surveillance to improve patient safety.

Teaching Tele sitters and nurses how to monitor patients this way is paramount to it

being successful. Recommendations regarding this project can be made to the quality

management department and hospital manager so as to ensure that everyone is compliant and

participates fully in the transition. Information will be provided to the other hospital units for

consideration of using video monitoring to promote patient safety.

Reference
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Centers for Disease Control and Prevention. (2017, February 10). Important Facts about Falls.

Centers for Disease Control and Prevention.

https://www.cdc.gov/homeandrecreationalsafety/falls/adultfalls.html.

Cournan, M., Fusco-Gessick, B., & Wright, L. (2018). Improving Patient Safety Through Video

Monitoring. Rehabilitation Nursing, 43(2), 111–115.

https://doi.org/10.1097/rnj.0000000000000089

Davis, J. E., & Carter-Templeton, H. (2020). Augmenting an Inpatient Fall Program with Video

Observation. Journal of Nursing Care Quality, 36(1), 62–66.

https://doi.org/10.1097/ncq.0000000000000486

Hamandi, K., Beniczky, S., Diehl, B., Kandler, R. H., Pressler, R. M., Sen, A., … Bagary, M.

(2017). Current practice and recommendations in UK epilepsy monitoring units. Report of

a national survey and workshop. Seizure, 50, 92–98.

https://doi.org/10.1016/j.seizure.2017.06.015

Joint Commission Center for Transforming Healthcare. (2021). Preventing Falls. Center for

Transforming Healthcare. https://www.centerfortransforminghealthcare.org/improvement-

topics/preventing-falls/.