Telehealth –Telenursing VisitsSECTION: 27.11

Strength of Evidence Level: 3__RN__LPN/LVN__HHA

PURPOSE:

To provide guidelines for implementing telenursing visits.

CONSIDERATIONS:

  1. Patients indicated as high risk for re-hospitalization atintake receive same day admissions or admission in theearly morning the following day. All patients that areindicated as high risk for re-hospitalization receive a phone call from agency staff on the day of dischargefrom the hospital or nursing home to introduce theagency and assess the need for a same day admissionvisit.
  2. Telenursing (audio/video visits) is an interactive process which allows the nurse to consult and evaluate the patient’s health status as well as provide education.The goal is to:
  3. Reduce avoidable hospitalizations.
  4. Identify early disease exacerbations.
  5. Improve patient self care management.
  6. Reduce unscheduled nurse visits.
  7. Agency staff will follow-up based on health statusassessment which may include:
  8. Education/counseling.
  9. Home treatment advisement.
  10. In-home nursing visit.
  11. Referral to physician or hospital.
  12. Disease management specific intervention.
  13. Urgent/emergency intervention.
  14. Evaluation of telehealth monitoring will occur periodically. Consider some of the following information:
  1. Process Evaluation

(1)Number of phone monitoring patient encounters.

(2)Number of telehealth monitor alert events.

(3)Number of telenursing visits.

(4)Other data, as deemed necessary.

  1. Outcome Evaluation

(1)Patient and provider demographics.

(2)Disease-related measures.

(3)Cost per case.

(4)Nursing productivity.

(5)Patient and provider satisfaction.

  1. Utilization rate of other healthcare services and impact of Outcome Based Quality Improvement (OBQI)/Outcome Based Quality Monitoring (OBQM) data:

(1)Emergent, unplanned care rates.

(2)Acute care hospitalization rates.

(3)End result OBQI measures.

(4)Home Health Compare.

(5)OBQM measures/adverse events.

EQUIPMENT:

Agency standard protocols

Patient plans of care

Emergency guidelines

Audio/Video equipment

PROCEDURE:

  1. Conduct video visits following the vendor’s user guide.
  2. Obtain patient consent to dial in on the video camera prior to initiating the video visit.
  3. Ensure that the visit is conducted in a room where the door can be closed to maintain patient privacy.
  4. Obtain patient’s verbal consent, if there are persons other than the clinician, who is conducting the visit, in the room. If the patient denies consent, the visitor must leave.
  5. Decrease video visits. Notify the physician of the reason why and consult with the physician to determine if additional measures or in home visits should be provided.
  6. If equipment failure prevents a scheduled video visit, contact the patient and physician. An in-home visit should be scheduled at the earliest convenience, based on the patient’s need and/or desire.

AFTER CARE:

1.Agency staff will document telenursing visit according to agency policy.

2.Patient information gathered during the telenursingencounters will be used for patient case conferences and considered when reviewing the plan of treatment/plan of care.

3.Telenursing monitoring may be discontinued when the clinician deems the process is no longer necessary. The patient/caregiver and physician should be informed and agree.

REFERENCES:

Centers for Medicare and Medicaid Services. Quality Insights of Pennsylvania. (2005).Home Telehealth Reference 2005 (7SOW-PA-HH05.151).