‘Patient-minding robots’ at some PRMC bedsides

Elizabeth Rios, RN, left, is one PRMC staff member assigned to watch the 10 individual room monitors linked to the AvaSure Telesitter robots watching assigned patients in their rooms. Right, PRMC bought 10 of these robots that include 360-degree cameras, audio and visual feeds.

Peterson Regional Medical Center has purchased 10 “AvaSure Telesitter” robots as a way for a single assigned staff member per shift to keep eyes on multiple patients who are deemed to need to be observed continuously.

Each telesitter mobile device is basically a 360-degree camera mounted on top of a pole above a two-way audio speaker; and this vertical assembly sits on an omni-directional wheelbase.

The whole assembly stands more than 6 feet tall; and can be wheeled into a patient’s room to stand across from the foot or side of the hospital bed, to be watching and listening.

“An assigned nurse sits in a separate office at a desk to watch the 10 individual video screens for each “robot” assigned to a patient’s room, to observe each of those patients,” said Lori Michel, R.N. and clinical coordinator of Nursing Services.

Previously, nurses on each shift were assigned to sit in person in some patients’ rooms as needed, for patient safety.

Michel said this technology was developed about 2014; and its specific uses are related to the community projects that also added anti-fall/monitoring beds and mattresses with alarms built in.

“We researched these and found great outcomes in large hospitals and public studies. They have proven to greatly reduce falls,” Michel said.

She said the staff assigns a telesitter to patients with a high risk of falls; or to patients who are confused in their thinking; or who may be tugging at their IVs and other medical lines.

“A person having a history of falls can be put in a high-risk category,” Michel said.

Michel said use of the telesitter “robots” isn’t usually considered for patients who are at high risk for suicide; and they assign nurses in one-on-one shifts to sit with those patients.

While the whole Telesitter assembly is tall and slender with no “arms,” it’s not lost on the hospital staff that the top camera assembly seems to call out for facial features and to be given names – “Wall-e” has come to mind already. But so far they haven’t gotten out big markers to draw eyes on them; and with no “arms,” they can’t be dressed in lab coats either.

According to the “Quick reference guide” that came with the new machines, the AvaSure Telesitter provides continuous visual monitoring of patients by trained monitor staff; and meets HIPPA and patient privacy requirements.

A nurse is assigned each shift to watch the monitors.

It has a “privacy mode” that can be activated by the monitoring staff during patient care. The video screen in the office where it’s being monitored goes blank so the nursing staff can provide in-person care as needed in the privacy of the patient’s room.

It is not battery-powered but plugs into the regular wall outlets.

The top part of the robot has an infrared light that is on when the camera is on and muted at night.

It indicates monitoring is active when the LED light on the device is “on.” Privacy mode is enabled when the privacy light on the device is “off.”

The telesitter is a “live feed” to the computer monitor, and does not record audio or video.

It does not replace the “nurse call button;” and it does not replace current safety measures.

Clinical staff responsibilities

The clinical staff in each in-patient ward and in the Emergency Room selects the patient(s) to be monitored, using criteria outlined in hospital policy and procedure.

Michel said their 10 telesitters are divided among the Emergency Room, and in-patient units including Acute Rehab Unit, 2- and 3-West wards, and the Intensive Care Unit.

“Families have told us they’re thankful we have the robots to help watch their family members. And nobody’s declined to have the continuous monitoring when we’ve asked,” she said.

The staff initiates monitoring per protocol.

They provide education on the use of the robot to the patient and/or family.

They oversee communication between the in-person clinical staff, the assigned monitoring staff, and the patients.

They notify the monitoring staff person when the patient will be out of the room, for example, to be taken for X-rays.

They request activation of the privacy mode when appropriate, such as when a patient’s doctor is checking on the patient, or when nurses are giving a patient a bed-bath.

They continuously reassess the patient’s monitoring needs.

They respond in person to each patient’s needs as requested by the monitoring staff member who’s looking at the video screens.

They recognize and respond to the “Stat Alarm” activation.

When appropriate, they make the decision to discharge a patient from the robotic monitoring.

Monitor staff responsibilities

The telesitters provide continuous monitoring for assigned patients.

Each one “interacts” with patients, per protocol, using two-way audio.

The “dashboard” on the computer screen that being monitored shows columns for the number of times the alarm in the patient’s room sounded, and other information, including which numbered robot is assigned to that room.

The staff member communicates observations and interventions to the patient care team.

They deploy a patient care team to the bedside when appropriate, depending on what they see on the video screen.

The telesitter turns on the privacy mode at the request of the patient care team. And the monitoring nurse activates the “Stat Alarm” when needed.

Michel said the telesitters were bought and received the last week of September at the local hospital.

Before they committed to ordering the new equipment, Michel said they checked in PRMC records to know how many “sitters” they used in person previously and how they were assigned before.

She said the new robots were delivered to PRMC equipped with multiple languages, most of which they haven’t needed, but they have used the Spanish mode to communicate with at least one patient, shortly after the robots arrived at the local hospital.

“We don’t have very many nurses who are fluent in Spanish, so that was a big help,” said Michel. “It helped us with questions we could answer yes or no, and told us how to answer some others.”

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