ISSUES IMPACTING CONTINUOUS PULSE OXIMETRY MONITORING AND WIRELESS CLINICIAN NOTIFICATION SYSTEM AFTER SURGERY

Abstract

Background: The VItal siGns monItoring with continuous puLse oximetry And wireless cliNiCian notification aftEr surgery (VIGILANCE) study was a randomized controlled trial designed to assess the impact of continuous vital sign monitoring with alerts to nursing staff on the incidence of postoperative complications in surgical ward patients. Multiple factors interfered with the eHealth intervention implementation and conduct of the VIGILANCE study. Through examination of these challenges, the overall aim of this thesis was to help foster an understanding of the difficulties related to eHealth intervention implementation. The specific objectives were to identify issues related to implementation of intervention system of the VIGILANCE study, and to evaluate the influence of these issues on intervention adoption. Methods: During the VIGILANCE study, issues affecting the implementation of the intervention were documented on case report forms, alarm event forms, and a nursing feedback questionnaire. In this thesis, the issues were identified and evaluated using the Clinical Adoption Framework. Results: The key issues identified include nursing workflow changes, patient withdrawal, wireless network connectivity, false alarms, monitor malfunction, probe issues, and wireless network standards. These issues affected the service, system and information quality. As a result, these issues impacted ‘access’ through decreased ability of nurses to make complete use of the monitors; ‘care quality’ of the trial intervention through decreased effectiveness; and ‘productivity’ through interference in the coordination of care, and thus decreased clinical adoption of the monitoring system. Conclusion: Patient monitoring with eHealth technology in surgical wards has the potential to improve patient outcomes. However, proper planning that includes engagement of front-line nurses, installation of appropriate wireless network infrastructure, and use of comfortable cableless devices are required to maximize the potential of continuous monitoring.