Download - Telemedicine
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Telemedicine
Lilith J. Hutchinson BSN, RN
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Objectives
• Define terminology regarding telemedicine /teleheath
• Review the historical presentation of this technology
• Present current expertise and enterprises incorporating telemedicine interfaces
• Learn how technology monitors management of the Intensive Care Unit (ICU)patient
• Discover the support and resources for the bedside nurse
• Explore the nursing practice in teleheath2
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Historical perspective• Studies documenting
patient benefit with access to intensivist.
• Gap between intensivist and un-served populations
• Linda Aiken nursing shortage studies
• Leapfrog Group established staffing standards of 24/7 for physicians in the ICU. 4
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Definition of terms• Telemedicine ~ Medical information
transmitted for patient safety by the inclusion of a camera and push button access to another human relationship.
• Tele-physician ~ The physician has training and certification in the care of the patients who require monitoring in a critical care setting.
• Tele-nurse ~ The nurse is one that has worked in a challenging critical care setting for at least five years. 5
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Telemedicine Programs
• Collaboration ~Team members engaged to be flexible in gaining positive patient health outcomes.
• Consultation ~ Contacting an expert individual to state a message and transfer ideas to reach an agreement.
• Surveillance ~ Close observation and inspection paying attention to response or lack of progression to health. 6
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Utilization of A Networking Technology
• ICU Consultations• Child Abuse• CHF monitoring• Updates Families of Neonates• Access for remote locations• Access for the medically
underserved populations.• Treatment of wounded
soldiers• Radiological consultations• Wound management• Emergency care
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Telemedicine Monitoring• Expand structures geographically to reach the
community• Optimize the safety of critical care services• Offer services to increase referrals and spread
out cost
• Organized Networking Visits– Ratios: Unit monitor / Hours covered
• Physicians• Nurse
– Fixed Costs• Work stations• Computers • Building
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Physicians
Meet credentialing polices for each hospital system
• Ventilator and Pharmacological trends
• Order implementations• Manage Coding
Patients• Radiological
Conferences
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E-NursesFive years of clinical ICU experience
• Assess baseline data for policy – Vent Bundle/DVT
prophylaxis– Sepsis/ microbiological – EKG rhythms/alarms
• Assess electrolyte correction • Glucose/Heparin verification• Educate partnership care• Facilitate contact with
Indiana Organ Procurement Association (IOPA )
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Equipment• Nurse are paired into monitoring pods
for continuous coverage• Real-time vital signs from bedside
monitor• E-Monitoring: Alarm Alerts, E-
profile ,care plan • Virtual patient record • Radiology evaluation per physician /
View written reports• Standards of care resource manual
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Assessment• 170 beds monitored in 4 hospitals 9 units• 6 nurses per shift/ 24 hour accountability• 1-2 physicians for 15 hours per day
( 4PM-7AM)• Patient Profile / correctly identified– Last 6 hours of VS trends–New lab notification and alerts – Physician tasks: line removal, meds,
protocols– Pertinent labs: ABG, Hg, WBC trends, lytes–History and progress notes 13
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Montoring Plans/Interventions• Labs: Transfusion / Electrolyte replacement– Creatinine clearance
• <30 Notify pharmacy if no documented renal disease
• Hypotension Bolus• Drip- Levophed / Dopamine• Vent bundle– Deep vein thrombosis prophylaxis (DVT)–Head of bed 30 degrees – Oral care
• Peptic Ulcer Disease (PUD) prevention– Eternal feedings/ Antacid 14
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Documentation• Care plans updated qshift/admission notes /• Studies– Evaluate aseptic technique for line placement• Hand washing / Sterile set up / Puncture attempts
– Sepsis • VS trends: HR >110, /WBC, bands, platelets/
• Interaction Statistics :– Paging, lab follow-up, patient safety, alarms,
medication /allergy incompatibilities
– Unit oral and written notification of new orders
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Evaluation• The survey looked at four areas• 1) confidence and trust,• 2) usefulness of information• 3) professionalism• 4) collaborative interactions.
The survey included two open-ended questions that asked the respondents to provide one positive aspect of the telemedicine unit and what aspect they would like to change. 16
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Bedside Nurse Viewpoint Categories
Telemedicine Consultations
Nurse Consultants
Surveillance
Emergent Patient Safety
Patient Collaborations 17
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Bedside Clinician Perspective Advantages
• Physician Assistance• Willingness to serve as an
assistant to support patient• Identifying untoward
trends• Mentoring to novice nurses• Collaborating outcomes
Disadvantages
• Similar levels of expertise
• Loss of bedside experience/assistance
• Timing interruptions
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References• Benner, P. From Novice to Expert:
Excellence and Power in Clinical Nursing Practice. New Jersey: Prentice Hall Health.
• Clarke, S., & Aiken, L. (2003). Failure to rescue. American Journal of Nursing, 103(1), 42-47.
• Breslow, B., Rosenfeld, B., Doerfler, M., Burke, G., Yates, G., Stone, D., et al. (2004). Effect of multiple-site intensive care unit telemedicine program on clinical and economic outcomes: An alternative paradigm for intensive staffing. Critical Care Medicine, 31(1), 31-38. 19
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Questions?
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