Wireless Monitoring Arrives in Acute Care

On Feb. 11 patients at Palomar Medical Center, Escondido, Calif. became recipients of state-of-the-art medicine that allows nurses and other healthcare providers to closely and continuously observe vital signs-remotely.

The wrist-worn monitoring devices catch medical problems, such as deteriorating conditions, as they happen.

The remote monitoring system also liberates patients from cumbersome, sometimes wall-mounted, devices.

“With the system in place, we are able to spot check the patient’s blood pressure and pulse quickly without waking or disturbing the patient,” said Meghan Jaremczuk, MSN, RN, PCCN, nurse manager of the trauma IMC and surgical acute care units at Palomar Medical Center.

“The ability to do quick spot checks allows us to identify changes in blood pressure and pulse and act on them in a timely manner.”

Palomar is the first hospital system in the world to implement the mobile, patient-worn monitoring system, but other hospitals in the U.S., Asia, Europe and Australia are in the early stages of implementing this revolutionary new technology.


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How Does It Work?

The body-worn monitor can be worn on either wrist and is a fully-functional, continuously monitoring device similar to a bedside or transport monitor. It can operate independently (stand-alone mode) or as part of a wireless network (networked mode), explained Gary Manning, Sotera Wireless vice president of global sales, business development.

“The monitor itself is similar to a large sports watch in size and weight (approximately 4 oz.), and comes with a color touch-screen to continuously measure and display heart rate/ECG, blood oxygen saturation, respiration rate, non-invasive blood pressure and skin temperature,” said Manning.

All vital sign data is transmitted wirelessly over the hospital’s existing WiFi network and can be viewed and managed from a central station/desktop PC, and also from mobile tablets or laptops. This allows nurses and other healthcare providers to be continuously connected to their patients no matter if they are in bed or walking the halls. Ultimately, it allows them to intervene, if necessary, as soon as possible.

“The central station viewer allows the display of all vital sign values, waveforms, tabular and graphical trends, alarms and events for all patients currently on the monitoring system,” said Manning. “It can also ‘zoom-in’ on one specific patient.”

All patient alarms are displayed and annunciated, alarms can be acknowledged and alarm settings can be changed. In addition, charting of vital sign information can be done in electronic form (i.e., connectivity to most EMR/HIT systems) as well as configurable print-outs.


In the future, the system will be able to continuously and non-invasively measure blood pressure (cNIBP) with arterial-line accuracy, without frequent cuff inflations, even on ambulatory patients, Manning remarked.

He noted that the thought of a hospital stay is frequently a point of stress for patients and their families, and commented that this system presents “a greater sense of confidence, while opening a new standard of care and increasing staff efficiency.”

The Importance of Continuous Monitoring

The nurses’ role in implementing this system involved placement and verification of the device as well as using it for taking vital signs and responding to alarms.

“Nurses take the patients’ vital signs at the same time as they always would; however, the [system] enabled them to have a way to quickly spot check vital signs as needed,” said Jaremczuk, adding that with the wireless system in place, she and other nurses are able to spot check the patient’s blood pressure and pulse quickly without waking or disturbing them.

“Patients being awakened from much needed sleep to have their vital signs taken will become a thing of the past,” Lorie Shoemaker, MSN, RN, DHA, NEA-BC, chief nursing executive, said in a press release.

“Rather than checking vital signs every several hours, our participating clinicians will be able to obtain continuous measurements without disturbing the patient, and receive instant alerts if a patient’s condition begins to deteriorate. At the bedside, they can simply tap the [system’s] mobile monitor for an instant reading of heart rate and pulse, or they can check from a remote viewing device.”


Nurses Make the Call

Questionnaire helps nurses direct phone conversations with patients.

Shoemaker added it’s important for patients to be up and moving around the units as soon as possible after their surgery. The implementation of the wrist-worn monitoring device will allow nurses and other healthcare providers to observe the patient’s vital signs during ambulation.

If anything looks amiss, nurses will be made aware immediately and will be able to take proper steps to keep them safe.

“The ability to do quick spot checks allows us to identify changes in blood pressure and pulse and act on them in a timely manner,” Jaremczuk said.

In the short time they’ve been using the wrist-worn monitoring devices, nurses have had some “great catches,” remarked Jaremczuk.

“Low oxygen saturation alarms alerted us to a patient who was taking off their oxygen, we have caught patients in new cardiac irregularities, and we have been better able to engage patients in their own self-monitoring as they perform activities of daily living,” she said.

Previously, continuous monitoring was only possible via direct observation. As a continuously available spot checking system, the remote monitoring system changes this.

“It has been important to emphasize that the [system] is simply a tool that can help nurses and physicians catch patients before they actively decline in status,” noted Jaremczuk. “If a nurse starts receiving alarms for a particular vital sign, it will prompt an appropriate nursing assessment at a time when one may not have been due. Ultimately, it leads to safer patient care and earlier intervention.”

According to Ben Kanter, MD, Palomar Health chief medical information officer, patient safety and comfort are the medical center’s “highest priorities.”

“Having reliable data about the patient’s condition is essential to responding to changes at the earliest possible time and thereby preventing deterioration or even death. The [system] allows for the delivery of accurate data in a consistent, non-invasive manner,” he said.


Trauma Pneumothorax

Nurses must understand physiological derangements and their role in restoring patients to optimal health.

The Future of Remote Monitoring at Palomar

Generally, post-surgical patients are in need of frequent monitoring as they recuperate after surgery. Because of this, Palomar chose to first use the system on a general surgical acute care floor for postoperative patients.

Jaremczuk remarked that the remote monitoring system helps nurses with frequent vital sign checks during this time.

“What compounds this usefulness is that the [system] is completely mobile,” she said. As post-op patients increase physical activity, they can wear the wrist-worn devices as they ambulate in the hallways.

“Many patients have been intrigued to watch some of their vital signs and it has enabled them to have more control over their care,” she added.

Shoemaker envisions using the mobile system on all med/surg patients at Palomar Medical Center as well as Pomerado Hospital in Poway, Calif.

“I believe it will quickly become the standard of care for med/surg patients once the technology is further refined and all phases have been approved by the FDA and rolled out,” she concluded.

Beth Puliti

is a freelance writer.

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