Patients on an adult mental health ward at Oxford Health will get a better night’s sleep thanks to the development of a new observation protocol.

In collaboration with Oxehealth, a company established out of the University of Oxford, the Vaughan Thomas Ward at the Warneford Hospital has introduced the Oxehealth Digital Care Assistant (DCA) in an effort to improve patient experience.

Regular patient observations are a necessary point of care on inpatient mental health wards, where risk assessments are frequently undertaken to ensure safety and wellbeing. On acute wards, individuals can receive level one (once per hour), level two (every 15 minutes), or level three (24/7) observations.

Though essential these observations can be immensely disruptive, especially when conducted throughout the night. Sleep is imperative in mental health recovery and frequent disruption can have a noticeable impact.

The DCA first came into being in 2016 when Professor John Geddes, consultant psychiatrist and director of research and development at Oxford Health, and Dr Alvaro Barrera, consultant psychiatrist at the trust and Oxford University honorary senior clinical lecturer, were discussing ways to improve patient care.

Together, the two came up with the idea to use sensors as a tool to monitor patients overnight to improve their quality of sleep and wellbeing, and hasten recovery while still ensuring their safety.

As head of the department of psychiatry at the University of Oxford, Professor Geddes was able to put Dr Barrera in touch with Oxehealth, a company founded by the biomedical engineering department at the university. Together they brought the novel idea to life with support from the National Institute for Health Research (NIHR) Oxford Health BRC and NIHR CLAHRC, with the service improvement project becoming a part of the Global Digital Exemplar work conducted at the trust.

In 2017, Oxford Health was one of just seven NHS trusts delivering mental healthcare to be named a Global Digital Exemplar for its innovative use of technology to care for people who use mental health services. The DCA is just one of the projects currently under this remit.

Professor Geddes said: “We all immediately saw the huge potential in the Oxehealth system for psychiatric inpatient care of the most seriously ill patients. The combined trust, Oxehealth and university team, led by Dr Barrera, has done a brilliant job in implementing and evaluating the system.

“I think it provides a model of how the BRC can help drive innovation and improve how we provide care, and this is just the beginning!”

While the innovative technology has previously been applied in research on falls in older adults with dementia, the DCA had never been used in the particularly challenging environment of an acute psychiatric setting, making the Vaughan Thomas pilot a trailblazer.

New technology for a new method

Using infrared illumination and an optical sensor, the DCA allows staff to spot-check level one and two patients by identifying their pulse and breathing rate using small changes in skin colour and chest movements, respectively, without entering the room or requiring physical contact of any kind.

Importantly, the DCA is not the same as video camera surveillance and does not provide a live video stream; it only serves up an image when taking the patient’s vital signs or when staff are alerted to a high-risk activity.

Rather, the system works by engaging its sensors to collect data and assist ward staff, who can access the content between 9.00pm and 9.00am to perform their routine checks, as pictured.

The DCA process is similar to standard observation protocols: staff use a video image to observe the patient and satisfy themselves that the patient’s location, posture and behaviour do not cause concern. If the patient is stationary, staff use the DCA to check the patient is breathing and complete their standard observation sheet. Staff use their clinical judgement at all times and, should it be deemed necessary, personal checks can be resumed at any point.

The patient-identifiable data from each night is stored for 24 hours so that ward staff have the chance to review any changes throughout the period and identify any noticeable events, under strict governance. The data is then wiped to maintain patient privacy and confidentiality, which is a main priority at the trust. In fact, the vast majority of all data collected is anonymized.

“This system is a real innovation in mental health; while you constantly see developments in physical care a change like this for mental health just hasn’t been seen in years,” Dr Barrera said.

“The sensors act as a valuable tool to improve patient experience and also free up nurses for other tasks, so they can dedicate more time to patients who need more intensive care.

“I think that the ward team, led by our matron, Carol Gee, must also be commended for their thoroughness and commitment to change and innovation. Without their work this would have not been possible,” he added.

After two and a half years of early-stage planning, testing, and supervision from the project’s steering committee, the modified protocol for night observations was launched in February and went live on Vaughan Thomas ward, monitoring a total of six beds in the highest acuity corridor.

Every patient involved has been offered the traditional method of observation or the DCA sensors; after hearing about the technology, the system has been selected by most patients on the ward.

What comes next for the DCA?

While still in the early stages of integration at the trust, preliminary results have been positive, with the DCA already selected as regional winner in Oxfordshire for the Future NHS Award in the 2019 NHS Parliamentary Awards, which will be announced on Wednesday, July 10.

Banbury MP Victoria Prentis put the project forward for the award based on positive feedback from the patients and staff involved, as well as comments from the Oxford Health executive board’s quality sub-committee.

Staff report that the system is easy to use and faster than traditional checks, and all patients using the protocol have commented on an improvement in sleep and increased feelings of safety; some have also said they feel more reassured of their privacy because of the DCA.

In the future Oxford Health is looking to continue changing the face of mental health care by rolling out the DCA across the organisation and sharing the technology with others, with an ongoing and robust evaluation at every stage.

Andrew Wood, clinical research lead nurse on Vaughan Thomas ward, said: “We are so happy to see the sensor system in action and are grateful for the dedication of the staff on the Vaughan Thomas ward and Oxehealth to make the project come to fruition.

“We are excited to see how this new system will benefit patients and are grateful for their support and patience throughout this process.”

The team is now considering the possibilities for further research with the optical sensor technology and the potential for new advances in care these may provide.