1. Zahs, Colleen M. RN
  2. Hagen, Mary M. RN

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Although I officially work in home care, I don't often get to meet my patients in person. Today though, I have been asked to stop at a skilled nursing facility (SNF) on my way to the e-Homecare office to retrieve telehealth monitoring equipment from a patient who was to be discharged. Except-as it turned out-she wasn't going home any time soon. I told Mrs. J. it was lovely to finally meet her and wrote myself a note to follow up with the discharge planner later in the day. Back in my car I placed a call to a second SNF to make sure a resident had actually arrived so I could install the monitoring equipment in her room. I learned the patient would be moved later that day to the second floor where telemonitoring patients are placed. The nurse advised that I wait until the end of my workday to do the install. At that point, I drove to the e-Homecare office.


My three nurse coworkers were already hard at work in the nurse monitoring room. They were each on their phones speaking with patients, offering skillful advisement and gentle coaching. Our busy telehealth program began in 2011 and we now monitor 180 to 200 patients per month. Telehealth Nurse Lanise was asking a patient with heart failure if she had any new swelling in her lower extremities, shortness of breath, coughing, or other symptoms related to fluid retention. Telehealth Nurse Coordinator Jesse was heard teaching her patient how to read food labels properly and interpret sodium levels. Telehealth Nurse Shawn was on the phone with a patient's physician, providing a report on the patient's condition and asking for advisement. Telehealth Nurse Kevan was working remotely, creating the priority list from his review of patient vital signs and survey answers, and determining whom he should call first.


Once I settled in and received my monitoring assignment, I noticed that one of our elderly and long-term private pay patients, Mrs. C., had an elevated blood pressure reading. This was very unusual for her so I called her immediately. She answered the phone and said "I know why you're calling me, it's about my blood pressure. I'm OK. I'll check it again in a few minutes. God bless you Honey, and God bless all of you, I am doing so well because of all your prayers. If you find yourself a sugar daddy, would you ask him if he has a brother for me? I hope you win the lottery. If you win, will you share it with me?" I chuckled, because this is a typical conversation with her. She does almost all the talking and she has a great sense of humor.


Next I called Mr. D., a patient with cancer. It appears he didn't input his temperature measurement this morning and he had some survey answers that indicated worsening of his reported symptoms of exhaustion and shortness of breath. The rest of his measurements received by Telehealth were within his normal limits. He willingly provided his temperature and said that on clinic days he will sometimes fail to enter his manual measurements. He reported that although his survey answers look like his condition is worsening; his responses are only due to him having more physical activity than usual recently. He insists he is fine and feels the same as usual. He went on to discuss his concern about where his dogs will go if he has to move. He is aware that his health is changing for the worse over the past year and knows he will soon have to move to a smaller residence or an assisted living facility. I verified during the phone call that a social worker is actively working with him, and that the home healthcare nurse continues to see him regularly. I told him that I would notify his nurse that I had checked on him today and will provide her with a copy of his recent vitals and survey responses to review.


The telemonitoring program for oncology patients who are receiving chemotherapy is one of our new programs. The goals are to increase the quality of life of our patients, minimize side effects by detecting symptoms early on and intervening, and decreasing emergency department (ED) visits/inpatient episodes. Our very first patient was Mrs. M., a woman in her early 40s with a young family and husband. Her husband was e-mailing the physician at least 20 to 30 times per week with concerns. The couple's anxiety levels were understandably through the roof. The patient was showing up in the ED weekly due to nausea and dehydration. When we began the program, we developed daily symptom surveys to closely monitor her fluid intake, appetite, and nutritional status. The home healthcare nurse worked with the spouse to teach administration of IV Zofran and a telehealth nurse spoke with the patient or her husband on a daily basis. The e-mails to the physician dropped to one per week and sometimes it was the physician who had initiated those e-mails. The patient did not have to go to the ED even once in the 3-month period that we were monitoring her. The patient, her husband, and the physician were very pleased with the entire experience. The husband said that it changed their lives.


Today is a special day for the telehealth team. One of our long-term patients is transitioning to hospice and her daughters have invited the entire team over to meet her in person and say goodbye. When we arrive, 93-year-old Maggie is in her recliner draped in a Wonder Woman blanket. Her daughters have snacks out for us and one daughter who couldn't be there in person is Skyping in over the large screen TV so that she can join the festivities. It is so wonderful to finally meet Maggie and to experience her family's closeness as her daughters talk about Maggie's life and show us photos. They express their gratitude to the telehealth team for their assistance in caring for her during the last few months. It's a great feeling to know that we have made a difference in this family's life.


On my way home, I stopped at the SNF. The patient is now on the second floor. I installed her equipment and explained the program. She's happy to meet one of the nurses who will be monitoring her condition, and I am happy to be able to put a face to the voice I will be speaking within the weeks to come.