Telemonitoring becomes tool for therapists
Telemonitoring becomes tool for therapists
High-risk cardiac patients benefit from extra 'eyes'
The ability to see that a patient was experiencing atrial flutter during a therapist's visit and arrange for an immediate visit to his doctor's office made it possible for the staff at BeyondFaith Homecare and Rehab in Lubbock, TX, to help a patient avoid a trip to the emergency department.
The patient was part of a telemonitored rehab program that includes the use of telemonitoring equipment and real-time monitoring by a cardiac nurse during therapeutic exercise sessions. "The gentleman had undergone a bypass and valve repair and was on dialysis," explains Sue Duty, RN, coordinator of the STAR (Safe Telemonitored Accelerated Rehab) program at the agency.
"I saw the atrial flutter as soon as the therapist hooked him up, so we continued to monitor him as we contacted his physician," she says. After seeing the physician, it was determined that the patient could not tolerate full dialysis sessions three times a week, so he was switched to shorter periods of dialysis every day, she explains. "This was an unanticipated benefit of the program but it kept the patient out of the hospital," she adds.
The STAR program utilizes the same type of equipment used to monitor patients' blood pressure, heart rate, and oxygen levels by nurses; but in this use, the equipment monitors the patient during therapeutic exercise and includes an electrocardiogram.
Patients in the program have been identified as high risk for cardiac events, says Paige Sarchet, OTR, director of rehabilitation for the home health agency. "Generally, the patients have had a stroke, bypass graft surgery, or heart attacks prior to home care," she says. The therapist uses leads to connect the patient to the base unit so that not only blood pressure and oxygen levels can be measured during therapy but also an ECG can be produced, she says.
Once the leads are connected, the therapist calls Duty who acquires the telephonic signal produced by the equipment so that she can view the results of the ECG on her computer screen as the therapy takes place. "I stay on the telephone with the therapist and patient throughout the session," says Duty. She maintains contact during the session so that she can ask questions of the patient if she notices changes in the ECG from previous sessions, she explains.
"I'll often ask more questions than the patient's nurse may ask because I am focused on cardiac-related issues and because I have more information about the patient's actual cardiac performance than the nurse might have because I see how the patient's heart performs while exercising," explains Duty. Questions she may ask include:
- What have you eaten prior to the therapy visit?
- How much and what type of fluids have you been drinking?
- Has your doctor changed any medications since the last visit?
When Duty asked one patient about fluids and medication, she found out that not only had the patient not been drinking but she also had been put on a diuretic, so she was dehydrated. "We were able to tell her to stop the diuretic and start drinking while we contacted her physician," she explains.
Duty had 18 years experience as a cardiac nurse prior to taking over as STAR program coordinator. "Cardiac experience is necessary for this position because you not only have to be proficient in reading rhythms, but you also have to know a lot about congestive heart failure, cardiac abnormalities, and signs and symptoms of cardiac distress," she explains. Most home health nurses don't have the luxury of focusing on only one disease or condition, so it is hard to develop the expertise necessary, she adds. A byproduct of the STAR program and Duty's expertise is that she has become a cardiac resource for all of the agency's nurses, she says. "I will get calls from nurses who are caring for patients that are not in the STAR program and I'm able to offer advice," she explains.
First-year changes put into place
Because this is a new program, there have been changes in the first year, points out Sarchet. "The first equipment we used required lead wires to connect the patients to the monitoring equipment and that did limit maneuverability," she admits. Although the limitations did not affect outcomes, the staff looked for ways to improve the sessions, she says. "Now, we have wireless equipment so therapists and patients are less restricted," she says.
"We learn more about the equipment and our capabilities as we use it so I expect more changes," says Sarchet. "In fact, we currently use an analog system to connect with the coordinator and when it is windy we do have some problems maintaining a connection." The next step for the program staff is to evaluate digital communications, she adds.
Physician feedback has been very positive, says Duty. "As we've evaluated the program, we see that all of our outcomes have improved and physicians feel comfortable with the monitoring that patients receive," she says. "They do ask for more complex ECGs but I'm limited to a single lead with the equipment and a single lead does meet our objectives," she says.
In addition to the therapist's notes in the patient's chart, Duty also completes a chart that contains her report and the ECG strips for the session. "I have six to 10 strips in a chart for each patient that shows the patient at rest between exercises and at peak for each exercise," she says. "As I'm monitoring the patient, I can look back at previous reports and strips to see if there are any changes."
Patients have been especially receptive to the monitoring, says Duty. "Patients, especially post-surgical patients, have told us that they like having someone watch their heart during exercise," she says. Because they are less anxious, they may be more compliant during the therapy, she admits. "We know that it is beneficial from a clinical perspective to monitor patients during therapy but patients like it because they feel safer."
Source
For more information about telerehabilitation, contact:
- Sue Duty, RN, STAR coordinator, BeyondFaith Homecare and Rehab, 5760 40th Street, #A-1, Lubbock, TX 79407. Phone: (972) 203-8200. E-mail: [email protected].
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