Specialist commentator comments
The commentators were generally positive about the potential for improvement offered by VitalPAC. They noted that there was an ongoing move towards electronic recording of vital signs and alerting of deterioration, and that several similar systems were available to do this. Electronic systems can improve the recognition and treatment of clinical deterioration and this can offer clinical benefit to patients, provided appropriate action is taken and the accuracy of vital sign assessment is ensured. One commentator added that electronic systems had potential to improve early warning score (EWS) scoring by eliminating arithmetic errors and allowing monitoring of completeness and compliance. In addition they can help with patient tracking and clinical and continuous audit, whereas paper-based systems can be difficult to audit.
One commentator noted that in standardising documentation practice and increasing transparency of risk assessments, VitalPAC could be used to drive cultural change unlike other interventions in the current NHS. But 2 commentators noted that the use of systems such as VitalPAC would be a part of a wider package of process management improvements needed in the acutely ill and deteriorating patient pathway. How alerts are triggered and how care is escalated would also need to be reviewed.
Some practical issues were raised for consideration in the implementation of systems such as VitalPAC. Reliable WiFi or other networking infrastructures would be needed. Another commentator said that they found it difficult to view trends in observation data on the small screens of the iPod devices.
Two commentators reflected that as VitalPAC does not monitor vital signs directly, there was potential for transcription errors to be made when entering vital sign data into the system. Similarly, alerting could be delayed if vital signs are not entered into VitalPAC immediately. Additionally, one noted that qualitative data, such as clinicians' concerns or patients' complaints are not recorded and therefore may be lost. Another commentator noted that blood test results cannot be incorporated into the alerting system.
One commentator was concerned by the 2 field safety notices relating to technical issues with VitalPAC, as users of the system tend to assume that the outputs of monitoring systems are correct. Another stated that 1 downside of VitalPAC was that the manufacturer does not make users' data available for open research or evaluation. One noted that the new clinical definition of sepsis reduced the importance of the alert for systemic inflammatory response syndrome.