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

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

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

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

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

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

Bedside Nurse Viewpoint Categories

Telemedicine Consultations

Nurse Consultants

Surveillance

Emergent Patient Safety

Patient Collaborations 17

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

Questions?

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