JONA Volume 39, Number 3, pp 123-129 Copyright B 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins THE JOURNAL OF NURSING ADMINISTRATION Impact of Continuous Vigilance Monitoring on Nursing Workflow T. Heather Herdman, PhD, RN Lawrence P.A. Burgess, MD Patricia R. Ebright, DNS, RN, CNS Shirley S. Paulson, MPA, RN Gail Powell-Cope, PhD, ARNP, FAAN Holly Hancock, MS, RN Edward Wada, MBA Edwin C. Cadman, MD Background: Increasing nursing time in patient care is beneficial in improving patient outcomes, but this is proving increasingly difficult with the nursing short- age, budgetary constraints, and higher patient acuity. Objective: Nursing workflow was evaluated after the implementation of a continuous vigilance moni- toring system to determine if the system enhanced patient-centric nursing care. Methods: Work sampling observations were con- ducted at 3 hospitals for 6 categories of nursing ac- tivities (direct and indirect nursing, documentation, administrative, housekeeping, and miscellaneous) at baseline and at 3 and 9 months. Results: Statistically significant increases in direct (3 months) and indirect nursing care (3 and 9 months) were found, with variability between sites. Statistically significant increases at 3 and 9 months for documen- tation of patient care activities and decreases in administrative activities were the most consistent findings for all sites. Conclusion: Continuous vigilance monitoring en- hanced patient-centric care with increases in direct and indirect nursing care and documentation of those activities. Thousands of patients die each year due to compro- mised patient safety in hospitals. In findings from Crossing the Quality Chasm: A New Health System for the 21st Century , 1 it was noted: BHealth care today harms too frequently and routinely fails to deliver its potential results.[ In the landmark report To Err Is Human, 2 it was estimated that between 44,000 and 98,000 Americans die unneces- sarily each year because of medical errors. Health- Grades 3 reported that Bmedical errors account for 195,000 preventable hospital deaths per year,[ with 75% of these preventable deaths associated with failure to rescue and death in low-mortality diag- nosis related groups, patient conditions routinely found on the general care ward or medical-surgical unit (MSU). In a report published by the Joint Commission, 4 researchers found that low nurse staffing levels were a contributing factor in nearly one-fourth of patient deaths and injuries since 1996. Likewise, when registered nurses (RNs) managed a heavier patient load, the risk of death and failure to rescue in surgical patients increased by 7% for each patient above 4 that an RN cared for. 5 National surveys of RNs and chief nursing officers were analyzed, with nearly two-thirds of respondents feeling that the following indicators of nursing practice could be improved upon: timely detection of patient JONA  Vol. 39, No. 3  March 2009 123 Authors’ Affiliations: Vice President for Nursing, Research and Patient Safety (Dr Herdman), Vice President for Medical Affairs (Dr Burgess), Clinical Nurse Educator (Ms Hancock), Customer Service and Clinical Research Manager (Mr Wada), Consultant (Dr Cadman), Hoana Medical, Inc, Honolulu, Hawaii; Professor of Surgery (Dr Burgess), Professor of Medicine (Dr Cadman), University of Hawaii School of Medicine, Honolulu; Research Fellow (Dr Ebright), Center for Research, Richard L. Roudebush Veterans’ Administration Medical Center, Indianapolis, Indiana; Associate Professor (Dr Ebright), Indiana University School of Nursing, Indianapolis; Chief Nurse Medicine, Surgery and Critical Care (Ms Paulson), Veterans’ Administration Palo Alto Health Care System, Palo Alto Hospital, California; and Associate Chief Nursing Service/Research (Dr Powell-Cope), James A. Haley Veterans’ Administrations Hospital, Tampa, Florida. Corresponding author: Dr Burgess, Hoana Medical, Inc, 828 Fort St Mall, Suite 620, Honolulu, HI 96813 (lburgess@ hoana.com). This study was funded by a grant through the US Army Med- ical Research and Materiel Command. Disclosure: Authors Herdman, Burgess, Hancock, Wada, and Cadman are employees or consultants of Hoana Medical, Inc. 9 Copyright @ 200 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.