course materials

1. NUR 4325 Central Video System versus Using Staff to Sit in Rooms
NUR 4325 Central Video System versus Using Staff to Sit in RoomsNUR 4325 Central Video
System versus Using Staff to Sit in RoomsNUR4325 Clinical Nurse Leadership Evidence-
Based Practice Project Description and Purpose: The evidence-based practice project
provides an opportunity for students to incorporate evidence into nursing practice.
Students will identify an issue or problem that requires additional evidence to it on the
clinical unit. Students will perform a literature review, apply the findings to nursing
practice, and disseminate the evidence to faculty and peer students. Gap Analysis Topic
Consideration: A gap analysis helps to identify gaps between ideal nursing standards and
nursing practice as it exists in the clinical setting. Essentially, it addresses the issue between
nursing as it is on the clinical unit versus how nursing should be in an ideal setting. Identify
a clinical problem from your current clinical setting. It can be related to a patient care
management issue or a unit management problem. 1. Consider the elements of the problem
as it currently exists. Be detailed enough so the problem is understood, but make sure to
maintain confidentiality. Be as objective as possible – state the problem without assigning
judgment to a person or organization. 2. Consider the desired future state or condition that
would ideally solve the problem. Again, avoid assigning blame or judgment. 3. What is the
gap between the ideal and real situations? 4. Once you have topic approved by faculty,
complete the COFT as described below: Steps in Completing COFT (Comparison of Findings
Table): 1. The student will identify a clinical problem within a clinical setting. 2. The student
will complete a literature search for at least 7-10 research articles. 3. The student will
complete a comparison of findings table for the 7-10 references obtained from the literature
search. NUR 4325 Central Video System versus Using Staff to Sit in RoomsThe comparison
of findings table is due Week 4 class day by 23:59 via Turnitin. 4. The student will develop a
professional presentation on the findings and recommendations for change to ideal nursing
practice from the comparison of findings table and will present in class on Week 7.
Comparison of Findings Table The comparison of findings table allows the students to
summarize and to organize the findings of research articles. It will also allow students to
quickly identify the important points of the articles and determine the similarities and
differences among the articles. After completing a literature search related to the problem
identified in the gap analysis, students will choose 7-10 pertinent research articles and
complete the comparison of findings table using the template attached. The student should
paraphrase and summarize the information from the articles. Copying and pasting from the
article into the table is not permitted, even if the information is cited as a direct quote. The

2. template is also available on Moodle. Presentation Requirements: The presentation
provides a forum for disseminating the findings of the gap analysis project. The
presentation will include a poster/powerpoint.ORDER NOW FOR CUSTOMIZED,
PLAGIARISM-FREE PAPERSThe poster/powerpoint should be professional, easy to read,
and creative and should contain the title of the project, the student’s name, the clinical
problem identified through the gap analysis, the background/significance of the project,
how the literature was collected, a summary of the research findings, any controversies or
limitations in the research, and recommendations for best nursing practice. A one-page
handout that summarizes the key points of the poster/PPT and includes a complete
reference list should be included with the presentation and submitted to the faculty.
Additionally, students should be prepared and knowledgeable to answer questions from
peer students about the topic NUR4098 Sp12 Adu Article Citation Research Question or
Hypothesis NUR4325 Comparison of Findings Table Sample, Setting, Outcomes to be
Findings and Design Measured Strengths and Limitations/ Conflicting Evidence Key Points
to Include on Poster 3 NUR4098 Sp12 Adu 4 Sonya L. Kowalski Rosanne Burson Elaine
Webber Margaret Freundl Budgeting for a Video Monitoring System to Reduce Patient Falls
and Sitter Costs: A Quality Improvement Project EXECUTIVE SUMMARY A review of
available evidence for the use of video monitors to reduce patient falls and bedside sitter
costs revealed few evidence-based, peer-reviewed articles. Large numbers of clinically
based reports in the form of poster and podium presentations were found. Available data
were used to stimulate interprofessional and collaboration for a video monitoring budget
plan as a quality improvement project intended to reduce patient falls and sitter costs at
one government healthcare facility. The process of data collection and analysis is detailed,
providing a blueprint for nurse leaders.NUR 4325 Central Video System versus Using Staff
to Sit in RoomsR EDUCING HEALTHCARE COSTS while improving patient outcomes and
experiences are explicit goals for healthcare organizations (Institute for Healthcare
Improvement [IHI], 2016). In an era of cost containment, healthcare organizations may be
reluctant to invest in costly innovations to meet these goals without significant evidence
that demonstrates efficacy of the intervention and timely return on investment. While
randomized controlled trials are slow, expensive, and time consuming, analyzing large
amounts of data collected from clinical care environments can create opportunity for
healthcare improvement (Haughom, 2018). According to the Institute of Medicine (1999),
“safety should be an explicit organizational goal” for health care (p. 4). Patient falls SONYA
L. KOWALSKI, DNP, RN, ACNS-BC, is Associate Clinical Professor, University of Detroit
Mercy, College of Health Professions, McAuley School of Nursing, Detroit, MI. ROSANNE
BURSON, DNP, RN, ACNS-BC, CNE, CDE, FAADE, is Associate Professor, University of Detroit
Mercy, College of Health Professions, McAuley School of Nursing, Detroit, MI. ELAINE
WEBBER, DNP, RN, PPCNP-BC, IBCLC, is Associate Clinical Professor, University of Detroit
Mercy, College of Health Professions, McAuley School of Nursing, Detroit, MI. MARGARET
FREUNDL, MSN, RN, is the retired Associate Chief Nurse for Research, Education,
Recruitment, and Professional Practice, John Dingell VA Medical Center, Detroit, MI.
NURSING ECONOMIC$/November-December 2018/Vol. 36/No. 6 have been identified as a
threat to patient safety in hospitals and are the number one reported adverse event, with

3. over 1 million falls reported in U.S. hospitals annually. Fall reports indicate approximately
33% of patient falls are preventable (Ganz, Huang, Saliba, & Shier, 2013). Injuries as a result
of falls are costly from the patient, family, and healthcare system perspectives. During the
past decade, the Centers for Medicare & Medicaid Services (2008) have not reimbursed
additional hospital costs associated with falls and fallrelated injuries. NUR 4325 Central
Video System versus Using Staff to Sit in RoomsHospitals are required by The Joint
Commission to have a fall-reduction program as a national safety standard (Jorgensen,
2011). Fall risk tools, such as the Morse Fall Score Tool, are utilized to identify patients at
high risk of falling and direct a protocol of standard interventions. Many hospitals have
attempted to reduce falls by placing sitters at the bedside of patients at high risk of falling
(Burtson & Vento, 2015; Jeffers et al., 2013; Votruba, Graham, Wisinski, & Syed, 2016).
Using available assessment tools, hospitals may determine which patients should be
provided with a direct observation sitter; however, there is little evidence the intervention
291 is effective in reducing fall-related injuries (Harding, 2010). Nevertheless, inpatient
sitter costs have been rising and may be as high as $3 million per year (Rochefort, Ward,
Ritchie, Girard, & Tamblyn, 2011). Problem Description A Midwest medical center has had
an interprofessional fall prevention taskforce in place for several years. The group
formulated a fall prevention protocol based on findings from the Morse scale assessment
scores. Additionally, bedside sitters were utilized to monitor patients identified as having
the highest risk of falling. The taskforce accomplished early gains in fall prevention, but over
time fall rates began to level out with minor variations over several years, based on data
from this facility’s incident report tool. It was determined that use of bedside sitters did not
lead to an appreciable decrease in patient falls, and aggregate fall rates fluctuated between
1.09 and 5.30 falls per 1,000 bed days of care between January 2013 and June 2016. Patient
fall injury rates were also noted to be among the highest among comparable facilities
according to the quality data reports within this large healthcare system of demographically
similar medical centers. Bedside sitters were typically utilized after the patient’s first fall if
fall prevention measures were considered likely to be ineffective due to patient
characteristics, such as impulsivity or dementia. Incident reports indicated patients
continued to fall even with 1:1 bedside sitters in attendance. The medical center did not
have a pool of available bedside sitters and therefore utilized existing staff to function as
sitters. The personnel utilized were nurse technicians, licensed vocational nurses, or
registered nurses. When a staff member was used as a sitter, either the employee worked
overtime or was removed from the unit’s staffing model. The latter option reduced the staff
available for patient care and made unit nurses 292 reluctant to request a sitter except in
the most severe cases. The annual sitter costs at the institution were estimated to be
$284,488.00 for acute care, $21,053.20 for long-term care, and $116,544.50 for mental
health units (total $422,086 annually). NUR 4325 Central Video System versus Using Staff to
Sit in RoomsThese estimates were obtained by utilizing staffing records and sitter salaries
from an average month, dividing by the number of days in the month to determine an
average daily cost, then annualizing by multiplying average daily cost by 365 days. The use
of staff as direct observation sitters was ineffective and expensive, contributing to staff
fatigue and dissatisfaction. The use of video monitoring to replace direct observation

4. bedside sitters to reduce patient falls was identified as a possible solution. Available
Knowledge A literature review was conducted searching for fall-reduction technologies,
including video monitors. The Cochrane Library, CINAHL, and PubMed Central were
searched for peer-reviewed articles within the last 10 years with keywords fall risk, fall
reduction, fall prevention, technology, video monitors, video surveillance, and video
cameras. Several technologies to reduce patient falls, such as smart shoes, smart carpet,
floor sensors, necklace sensors, and personal airbags, have been developed, but liability and
practicality issues have not led to market availability (Comstock, 2013). Only a few
peerreviewed, evidence-based articles were available to use of video monitors to improve
patient safety and reduce fall rates. The use of video monitoring within healthcare systems
to address the important issue of patient fall reduction has been of interest to nurse leaders
since Denver Health described the use of video monitors as part of a Lean journey (Jeffers et
al., 2013), but evidence has been lacking. Available peer-reviewed evidence included that
Burtson and Vento (2015) implemented a mobile video monitoring system (VMS) to reduce
the use of bedside sitters. The results of the study found decreased falls, fall-related injuries,
use of restraints, and sitter-related costs. Additionally, Votruba and coauthors (2016) found
use of video monitors to be not only cost effective, but also safe for use in fall
prevention.NUR 4325 Central Video System versus Using Staff to Sit in RoomsAfter
understanding potential cost savings and safety of utilizing a VMS to replace bedside sitters,
the next logical step was developing a plan to demonstrate the potential benefits within the
local healthcare facility. The literature search was then expanded to include gray literature,
such as non-refereed sources and healthcare websites. A large number of poster and
podium-presented data was available. These data reports indicated that with use of video
monitors sitter use declined, patient fall rates were reduced, fall injuries were reduced,
return on investment was rapid, and sitter cost avoidance was substantial, with the lowest
annual site-specific savings estimate reported at $77,200 (Votruba et, al., 2016). No reports
indicated regret over adopting the system. A VMS utilized by a healthcare system was
demonstrated at a national conference (Lee, 2016). Nurse managers and nurse users of the
system gave testimonials about benefits of the system and shared facility data outcomes
reports. Similar positive outcomes were reported during several site visits to hospitals
where video systems were being utilized. Specific Aims Video monitoring technology is
expanding rapidly and becoming a standard of care among the healthcare systems in this
Midwest region. Facility adoption of a VMS was viewed as necessary to provide regionally
equitable levels of monitoring for at-risk patients. An analysis of costs and benefits of the
VMS to the hospital was intended to demonstrate the feasibility of adopting this technology
as a quality improvement project. The purpose of this project was to utilize available
evidence to create a budget proposal and work with an interprofessional team to prepare
for implementation of a VMS in a healthcare organization in the NURSING
ECONOMIC$/November-December 2018/Vol. 36/No. 6 Midwest. Due to this hospital
system’s budget planning constraints, it was anticipated that if the budget proposal was
accepted, the time frame until implementation could be greater than a year or longer.
Because the budget proposal portion of the project did not involve any patients and the
expected time frame was lengthy, it was agreed by all participants to defer institutional

5. review board approval for the quality improvement study until the budget proposal was
accepted, funding was approved, and a purchase in progress. This article is designed to
create a blueprint for assembling clinically based data and working with an
interprofessional team including medical center leadership, nurse managers, fall-prevention
committee, biomedical engineering, and quality and safety managers, to create a budget
proposal for this healthcare innovation aimed at reducing patient falls. The clinical
questions proposed were: If the typical sitter model of staffing were to be replaced with the
video monitor model of staffing at this medical center: 1. What could be the sitter and fall-
related cost savings to the facility? 2.NUR 4325 Central Video System versus Using Staff to
Sit in RoomsHow could fall rates and fall injury rates be affected? 3. How much staff could
be returned to the unit? Methods Facility fall rates have been trended on an ongoing basis.
The fall and fall-related injury costs were estimated by annualizing a 6-month record of falls
and fallrelated injuries and multiplying the most recent and conservative cost estimates
from the literature within the injury categories of none ($1,139), minor ($7,136), and major
($30,931) by the number of falls within each category (Spetz, Brown, & Aydin, 2015).
Patient falls with no reported injury were estimated utilizing the no-injury cost calculation.
The cost estimate total for combined non-injurious falls and fall-related injuries was
$403,728. Gray literature reports video monitoring fall reductions ranging from 6% to 99%
with a 50% reduction near median. A 50% reduction in non-injurious falls would result in
an estimated annual cost savings of $61,506 (54 falls with no injury or no injury reported
multiplied by lowest cost estimate of $1,139 from the literature and reduced by 50%). A
50% reduction in fall-related injury costs would result in an estimated annual cost savings
of $140,358 (11 falls with minor injury multiplied by lowest cost estimate from the
literature of $7,136 plus two falls with major injury multiplied by lowest cost estimate from
the literature of $30,931 and reduced by 50%). The 1-year facility sitter costs were
estimated to be $422,086 and were calculated by annualizing the daily sitter costs from an
average month of actual staffing records using average salaries for the categories of staff
utilized. Financial Narrative A financial narrative was completed and presented to facility
stakeholders to gain for the project. The cost of the VMS was estimated to produce an
overall savings to the facility within less than a year after implementation. The estimated
cost of the VMS was projected to be less than $150,000 for an initial purchase of eight video
monitors, including equipment, installation, and staff training. The monitors were estimated
to be $10,000 each for a total cost of $80,000 for eight monitors (verbal statement by a
regional healthcare system user). The cost of establishing a central monitoring area was
estimated to be $30,000 (Browne & Sterne, 2015). The cost of licensing and system was
not available until the formal bid process but was estimated to be approximately $20,000
annually. The subsequent staff costs were projected as cost neutral because existing nursing
staff would be utilized as trained video monitor technicians in the same monitoring station
as centralized cardiac telemetry. The number of full-time equivalents (FTEs) to staff 24/7
would be NURSING ECONOMIC$/November-December 2018/Vol. 36/No. 6 five, and the
average hourly wage of certified nursing assistants was $19.10. (Use of unit managers,
technology, and biomedical was considered a part of normal job duties and not included in
calculations.) Based on the facility reports, approximately 25% of bedside sitters are

6. utilized in the mental health units and direct observation for many of those patients will
continue to be required. NUR 4325 Central Video System versus Using Staff to Sit in
Rooms’Therefore, a reduction of bedside sitter use of 75% was anticipated. Using the
calculated bedside sitter cost to the facility of $422,086, a 75% reduction in bedside sitter
costs would result in an estimated $316,564 annual savings. Total annual cost savings of the
VMS for both avoided sitter costs ($316,564) and avoided fall-related costs ($61,506 +
$140,358 = $201,864) was estimated to be $518,428. After adjusting for costs of the system,
the first-year cost avoidance for the VMS was estimated to be $368,428 ($518,428 –
$150,000) for the facility. Total 3year estimated fall-related costs of using a VMS were
$1,093,531 (see Table 1). Total 3-year estimated costs of continuing current bedside sitter
practice was estimated to be $2,477,442. Estimated 3-year fallrelated cost savings with the
use of the VMS was $1,383,910 (see Table 2). Proposed Intervention The proposed
intervention was to implement a VMS with threeway communication to replace bedside
sitters for all patients not on suicide precautions within the inpatient units of the medical
center. This intervention was designed as a quality improvement project. The Plan-Do-
Study-Act cycle was utilized to implement the project (IHI, 2016). After budget approval,
system installation, staff training, and pre-implementation data collection, the VMS would
be implemented with an initial capacity of eight patients. The eight video monitors would be
on a single screen placed in the telemetry monitoring station, which then utilized existing
staff (one person already being used for telemetry 293 Table NUR 4325 Central Video
System versus Using Staff to Sit in Rooms