The emergence of electronic monitoring in the home care setting has promise as a reliable and accurate method to improve patient outcomes and resource utilization. The nursing shortage and changes in reimbursement have impacted the traditional data collection visits in the home care setting. Today's health care addresses prevention and wellness on one end of the spectrum and management of chronic illness on the other, yet the majority of care needed is in the vast middle.
More and more health care will be provided in the home or as community-based care. Cost containment is still an important issue, and the use of technology to provide care at a distance will become an important advantage.
Telemedicine, an important new tool in the delivery of health care, uses live audio, video, and medical peripherals to assess the patient via a "video visit." These small, unobtrusive devices are simple to use and are not frightening computer systems, particularly when used by the elderly. Within a few minutes, a device can collect daily health indicators such as heart rate, blood pressure, oxygen saturation, temperature, weight, blood glucose, lung function, and prothrombin time. It can even use digital imagery to observe and measure a wound and drainage in a patient's home, transmitting information to a central location using a POTS or ordinary telephone line.
This technology is less expensive than a nursing visit but can provide daily coverage instead of a fixed number of visits per week. In addition, staff members are able to schedule visits according to patient needs and thus make visits when appropriate rather than according to a schedule.
Daily monitoring can increase the quality of life for patients and prevent costly readmissions to the hospital or emergency room. Application capabilities include tracking and trending patient data and recording and viewing nurse or physician notes. Parameters are set by the physician and the system alarms to notify the nurse when parameters are not within normal limits, allowing immediate intervention.
Orthopaedic nurses in the home care setting assess and modify the patient's environment, assess the availability and quality of client resources, and determine other professional disciplines that should be included on the health care team to provide holistic, comprehensive care. Through digital imagery, the orthopaedic nurse will be able to provide care without leaving the office. Advantages of the video visits include reinforcement of patient teaching and a focused opportunity to discuss the patient's health.
Certainly disadvantages such as cost, reluctance of older patients to use technology, and loss of human contact are important, but they can be offset by making visits that are necessary while still empowering patients to be independent in their care.
Telemedicine should be viewed as an adjunct, not a replacement for the nurse. With the reality of a nursing shortage, use of telemedicine reduces nursing visits while still providing daily care for a patient. Daily knowledge helps the nurse treat the patient better, improving quality of life and outcomes for the patient.
Shifting to a telemonitoring model reduces visits without sacrificing outcomes. In October 2000, Medicare reimbursement policies changed to allow for reimbursement for an encounter rather than an inperson visit. This gave agencies more flexibility in managing patients and opened the way to supplement inperson visits.
Although telemedicine is not yet commonplace, it provides an example of the use of technology to expand services to home care patients. Nurses can humanize technology, using it as another patient care tool.
Jayne Crescimbeni-Pierce, NP, ONC, and NAON's Sports Medicine SIG facilitator, has been chosen as a member of the Salt Lake City 2002 Olympic Torch Relay. Representing the Bloomington, Indiana, district of the relay, Jane will carry the Olympic flame about one-half mile before lighting the torch of the next relay member.
Relay participants are nominated by friends, colleagues, or family members and are selected on the basis of their ability to inspire, provide service to the community, or represent the Olympic spirit.
Jayne commented, "It's an honor to have been chosen for what others perceive I have given back to the community and to orthopaedic patients. I hope that all orthopaedic nurses and NAON members know that I will carry the torch not only to embody the Olympic and American spirit, but for all that orthopaedic nurses have done to return their patients to health and activity."
The AAOS recently suggested that physicians help patients deal with airport security checks by offering them a letter or card as proof of implant surgery. AAOS advises, however, that a note from a physician will not necessarily speed up the move through security. If an alarm sounds, the Federal Aviation Administration requires a resolution; a hand-held screener is used and, if needed, the implant patient must consent to a noninvasive body search to board the plane. Help your patients be prepared for airline travel by reminding them of this process.