Telehealth and the Homebound Heart Failure Patient

Transcription

1 Telehealth and the Homebound Heart Failure Patient By Karen Malin Garfield, RN, BSN 104 HEART 2010 The Official Guide to a Strong Heart and Healthy Lifestyle PTS Article Heart2010_Suncrest.indd 1

2 Health care providers are looking for better ways of taking care of their chronically ill patients in this increasingly cost conscious healthcare environment. Home care continues to be the most cost effective means of managing these patients and with many technological tools available today, the clinical outcomes for these patients can even be improved. One of the tools being utilized by innovative home care providers is telehealth. order for telehealth. Within 2 days Mr. T was put on a telehealth system that included the daily use of a scale, a blood pressure unit, a pulse oximeter and the communication hub, the telestation that would transmit all his information over to SunCrest Home Health daily. A former critical care nurse/home health nurse would be reviewing his information daily and alerting his visiting nurse to any Telehealth uses monitors in a patient s home to track such pertinent information as the patient s weight, blood pressure and oxygen saturation. significant changes in his vital signs and in how he was feeling. Mr. T s physician had discharged him on an ace inhibitor (used primarily in treatment of hypertension and congestive heart failure) but soon realized on telehealth T elehealth uses monitors in a patient s home to track such pertinent information as the patient s weight, blood pressure and oxygen saturation. Through the telecommunication device left in the patient s home, vital sign information is sent to a central repository where the information is reviewed and interpreted. The patient is taught how to take their weight, blood pressure and oxygen saturation measurements daily, and everyday a clinician reviews the information and interacts with the patient via the phone line. In the event that the patient s vital signs are trending poorly and the patient s status is changing, the telehealth nurse will send a home care nurse out to assess the patient. At 68 years old, Mr. T was a newly diagnosed heart failure patient who had already suffered his fair share of health issues. He was overweight and consuming several alcoholic beverages a day not the healthiest of patients. After leaving the hospital, Mr. T was discharged to SunCrest Home Health; due to his diagnosis of congestive heart failure we asked his referring physician for an The Official Guide to a Strong Heart and Healthy Lifestyle HEART 2010 PTS Article Heart2010_Suncrest.indd 2 105

3 that his pressures ran high and his heart rate was consistently over 110. When the telehealth nurse spoke with Mr. T, she noticed that he had a cough, a known side effect of an ace inhibitor. The SunCrest home health nurse notified the physician that Mr. T had a cough and could also benefit from being on a daily ECG rhythm strip. The 16 second rhythm strip indicated a fast heart rate and Mr. T was referred to a cardiologist. Upon seeing the cardiologist, Mr. T was taken off the ace inhibitor and given a medication for his blood pressure and a new medication for his heart rate. Within a few days, his heart rate came down to the 80 s and 90 s. Overtime he lost weight due to the daily diet teaching done by the telehealth nurse and the SunCrest Home Health nurse. At the end of 60 days, Mr. T was 106 discharged from home health without any other incidences and no rehospitalizations. In early October 2009, SunCrest Home Health implemented a comprehensive heart failure program in conjunction with the utilization of Philips telemonitors. The plan included detailed education for the SunCrest nurses on pathophysiology of the heart failure patient, common medications and signs and symptoms of exacerbation of the disease. The plan also included Clinical Pathways on Heart Failure for the home health nurse to understand fully what plan of care needed to occur and what patient teaching needed to be done on which skilled nursing visits. Left in the patient s home was the telehealth equipment, a guide for the patient taking his or her vital signs and a Patient Teaching Guide that described everything from the heart failure disease process to the heart failure zones; all in layman s terms. To do the daily monitoring of the telehealth patients seven days a week, SunCrest decided to employ the services of a few of SunCrest s Home Health nurses with critical care experience. Critical care experience was needed for this role because of the complexity of the treatment of a heart failure patient. The Central Monitoring Nurse, Roslyn Sandel, RN has over 40 years of nursing experience and 20 of those years were spent in the critical care area. Roslyn coordinates the team of other SunCrest HEART 2010 The Official Guide to a Strong Heart and Healthy Lifestyle PTS Article Heart2010_Suncrest.indd 3

4 his rhythm strip showed an atrial fibrillation rhythm. We had found out that Mr. Z had been on digitalis for quite some time and he was also on a beta blocker to control his heart rate. Concerned about possible digitalis toxicity, we faxed a copy of his rhythm strip to his physician. The physician stopped the digitalis and the dose of his beta blocker was cut in half. His physician ultimately put him on a different medication from digitalis and Mr. Z stabilized. Today, Mr. Z is still in our care and his rhythm is still atrial fibrillation but now his rate is in the 60 s instead of the 30 s-40 s and thus he is feeling much better. At present, SunCrest does not get reimbursed for the telehealth monitors that are utilized by the heart failure patients. Thus, one of the main corporate goals of the program is to help reduce the nurses who watch the telehealth patients and each SunCrest office receives a call if any of the patients are trending poorly. Roslyn explains, looking at the patients daily on the monitors does not take away from the assessment skills that the SunCrest Home Health nurse utilizes to fully determine the patient s status. We supply the nurses (and ultimately the physicians) with more frequent information on the patients status. Left in the patient s home was the telehealth equipment, a guide for the patient taking his or her vital signs and a Patient Teaching Guide that described everything from the heart failure disease process to the heart failure zones; all in layman s terms. Upon the initial rollout of the program, SunCrest focused on the sickest patients; those who had been hospitalized at least once for heart failure in the last 6 months. We also targeted the frequent flyer patients who had been difficult to manage at home and realized that if we could help these patients manage their disease at home, the other patients would be less challenging. Mr. Z was one of those frequent flyer heart failure (HF) patients. He was a long-standing HF patient in his 80s and so agoraphobic that he hated going to his doctor and thus he definitely did not want to be re-hospitalized anytime soon. When SunCrest Home Health received Mr. Z in their care, they immediately asked his physician for an order for telehealth. Upon putting Mr. Z on telehealth, it was noticed that he had a low heart rate in the 30 s and The Official Guide to a Strong Heart and Healthy Lifestyle HEART 2010 PTS Article Heart2010_Suncrest.indd 4 107

5 Everyday SunCrest is able to do another early intervention on their homebound heart failure patients through their telehealth program. 108 HEART 2010 The Official Guide to a Strong Heart and Healthy Lifestyle PTS Article Heart2010_Suncrest.indd 5

6 We supply the nurses (and ultimately the physicians) with more frequent information on the patients status. (O2) saturation was lower than usual in the low to mid 80s. She was receiving 3 liters of oxygen continuously and not getting any better. The local SunCrest Karen Malin Garfield, RN, BSN is a seasoned healthcare professional with over 25 years of experience in all levels of business development and client and portfolio management. Having worked in a variety of healthcare environments, Karen has extensive knowledge on both the provider and supplier side, having held leadership positions with General Electric Healthcare, Medtronic and Hill-Rom. In her current position as Corporate Director of Clinical Development, Karen oversees the formation and implementation of the SunCrest clinical programs such as, but not limited to heart failure, telehealth and falls prevention. Karen holds a BS in Nursing from The University of Texas Arlington and has practiced as a cardiac nurse at Baylor University Medical Center in Dallas. She recently completed an RN refresher course at Vanderbilt University. re-hospitalization rate of these patients and to partner with acute care facilities to help manage these patients at home. SunCrest president Wally Dant sees it this way, in eight months with our program we have been able to reduce the re-hospitalization rate of these telehealth patients by 50% - that is a compelling statistic to tout to any hospital administrator who is troubled by decreased reimbursement for these patients. Everyday SunCrest is able to do another early intervention on their homebound heart failure patients through their telehealth program. Mrs. C was being monitored at home and was also on home oxygen. We were unable to get a daily weight on Mrs. C due to a recent fall and how unsteady she was on her feet. One day recently her oxygen obviously we didn t prevent the re-hospitalizaiton of Mrs. C but we may have saved her life through our telehealth program. Karen Malin Garfield, RN, BSN nurse was called to make a visit to Mrs. C. She was found to be running a temperature and upon assessment, fluid was heard in her lungs. The nurse was concerned Mrs. C had developed pneumonia and had her sent to the hospital. Roslyn Sandel knows the value that is being provided to these patients, SunCrest Healthcare, Inc., based in Nashville, Tennessee, is a leading regional provider of home health, private duty, companion care and therapy services across the southeast. SunCrest has over 50 locations in Alabama, Florida, Georgia, Mississippi, Missouri, and Tennessee. SunCrest is dedicated to providing compassionate quality services to our patients and their families while recognizing the valuable relationship with our employees, referral sources and communities we serve. For more information visit The Official Guide to a Strong Heart and Healthy Lifestyle HEART 2010 PTS Article Heart2010_Suncrest.indd 6 109