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Leading the way in making every breath count

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Respiratory rate is the single most sensitive predictor of patient deterioration, yet the one vital sign that nurses currently must measure in a time consuming and imperfect fashion. But a smart device called RespiraSense is trying to change all that

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Leading the way in making every breath count

Identifying patient deterioration early is a key means of preventing harm, and a constant task for nurses. A range of observations support that mission. But, of them all, respiratory rate is the single most reliable predictor of deterioration. If a patient is getting sicker, it is his or her respiration that will indicate it first. Indeed, as far back as 1993, researchers found that a respiratory rate of higher than 27 breaths a minute was the most important predictor of cardiac arrest in hospital wards.

More recent research suggests that an adult with a respiratory rate of more than 20 breaths a minute is probably unwell. If the figure is over 24 breaths a minute, it is likely the individual is critical ill.

The importance of this indicator is clearly recognised in the new version of the National Early Warning Score (NEWS 2), for which implementation is mandatory next year. The score has respiratory rate as a key component.

And yet, of all the vital signs nurses record on a daily basis, the rate at which a patient is breathing is the one which is trickiest to monitor objectively. Manually counting patient respiration is time consuming and that can, in turn mean this critical observation is not consistently taken. Even when it is, the result is prone to error.

The difficulties around manual counting are self-evident and understandable. The other reality, however, is that patients are coming to harm as a result.

In 2012, it was reported that 31% of preventable general ward deaths in the UK were caused by poor clinical monitoring. That these wards often have challenging nurse-to-patient ratios seems unlikely to be a coincidence.

This troubling and tricky situation was one that Myles Murray and colleagues at PMD Solutions wanted to address. They reasoned there had to be a better way of assessing respiratory rate – and so aiding nurses to spot deterioration early.

Their solution? A monitor which continually assesses the rate at which a patient is breathing. RespiraSense has been seven years in the making. The small, continuous and motion-tolerant device is worn on the body in combination with a single-use sensor and integrates with electronic health records. Should the patient’s respiratory rate become cause for concern, the RespiraSense sends an alert to staff but also alarms locally – helping to ensure that the patient is seen by the right person at the right time. Alert boundaries are set in line with NEWS2.

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Leading the way in making every breath count

RespiraSense has been accepted onto the NHS Innovation Accelerator

The device has already been evaluated in seven clinical studies across 400 patients. Case studies suggest that objective and continuous monitoring with the device can identify elevated NEWS scores up to 12 hours earlier and with up to 80% sensitivity and specificity in cases of patients with abnormal blood chemistry. This means clinicians can intervene early in the event of deterioration, reducing the risk of patient harm and in turn, reducing length of patient stay.

“By using the RespiraSense device and trusting the respiratory rate, we were able to move the patient to a general ward room one day sooner than we would have without the use of the device,” said Peter Smith, consultant anaesthetist and intensive care unit director at Bradford Royal Infirmary. “This is due to the accuracy of the device and the confidence we had in it to be a more clear and accurate predictor of deterioration,” he said. 

National bodies have also demonstrated confidence in the device. The National Institute for Health and Care Excellence evaluated the economic benefits last year and, as a result, RespiraSense was accepted onto the NHS Innovation Accelerator. The scheme is designed to help rapidly accelerate the spread of high-impact, evidence-based innovations across the NHS and healthcare more broadly.

For Mr Murray, the founder and chief executive of PMD Solutions, the overall aim is simple: to enable the NHS to become the first healthcare system in the world to tackle inaccurate monitoring of respiratory rate. The benefits for nurses and patients alike are clear. 

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