Suzi Birz, principal, HiQ Analytics, LLC
The Central Coast Visiting Nurse Association and Hospice in Monterey, California, (CCVNA) has found that it can stretch the resources of the homecare nurses while providing better case management by using a telehomecare system.
CCVNA’s TeleHomeCare consists of placing a visual or monitoring units lightweight unit, in the patient’s home and attaching it to their regular telephone line. The unit connects to the Visiting Nurse Associate (VNA) office and allows the patient and nurse to both see and talk with each other. By using peripheral attachments, patients are able to transmit blood oxygen levels, weight and blood pressure to the VNA over these same regular telephone lines. Non-visual units also are in use and take the same statistics, with the home visual screen.
TeleHomeCare supplements the actual weekly home visits and is especially useful for patients with COPD and CHF.
“TeleHomeCare allows better management of cases and alleviates unnecessary visits while ensuring visits that must be done,” described Kathleen Griffon, RN, BSN the Telehomecare Coordinator for CCVNA. “Traditional homecare revolved around a pre-determined visit schedule set at the onset of the treatment plan, but these schedules were often of no clinical significance as time passed.”
“In contrast, TeleHomeCare provides frequent interaction between the nurse and the patient, almost daily monitoring of clinical indicators and the opportunity for the nurse to teach the patient about his or her own care,” explained Griffon. “If we teach patients to take care of themselves, then we reduce the feeling of abandonment that patients feel when their homecare comes to an end and the nurse discharges the patient from service.”
Each day, a patient with the TeleHomeCare equipment takes his or her readings and sends the information to the VNA. The vital signs appear on the screen so the patient can make a record of them.
In addition to the clinical readings, there are six to 10 diagnosis-related questions. These questions might include: Have you used your nebulizer today? Do you feel more shortness of breath today? Do you feel more fatigued today? Finally, the patient answers the question, Would you like to speak to your clinician today?
The process has become important to the patients. “If they turn away and miss the display of the vitals, they call me and ask me for the readings, demonstrating their involvement in their own care,” explained Griffon.
In a typical day, Griffon reads the information coming in from the patients between 9am and 3pm. If a reading is outside the bounds of the preset parameters, an alert message appears. Based on that alert, Griffon contacts the patient and arranges for a visit if necessary.
VNA sends the test results and other findings to the patient’s physician.
Doctors refer people they believe would be good candidates for the monitors to CCVNA. If a monitor is available it is assigned. “The success of the program has put the monitors in high demand.” explained Griffon.
“With our target population being those on Medicare, we see patients aged 65 to 95 and we are finding that the patient and/or the caregiver have no trouble using the monitors,” explained Griffon. “Also, we have a strong interest in getting the newly diagnosed patients in the TeleHomeCare Program right away.”
“Our method reflects the way adults learn,” said Griffon. “We teach them about their disease as quickly as we can and reinforce the education as much as we can prior to discharge.”
CCVNA is seeing results that indicate they are achieving their goals of decreased hospitalizations after discharge and decreased emergency room visits. “We see it improving early detection and intervention for our chronically ill, home-bound patients,” said Griffon.
In addition to the ongoing virtual homecare visits, the video phone technology allows nurses to view wounds, dressings and overall physical appearance from the VNA office. Nurses are working with newly diagnosed diabetics on insulin injections and education. The visual aids show promise for many types of TeleHomeCare visits.
“Telehomecare provides the ability to see a patient when clinically indicated not when scheduled and to meet the patient care requirements while helping to ease the burden of the nursing shortage,” summarized Griffon.
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