1. Verrips, Kim RN, CHPN
  2. Pierotti, Danielle PhD, RN, CENP, AOCN, CHPN

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Digital technology is as much a force for change in healthcare as anywhere else in society. The ability to connect people across large spaces, offer decision support for complex problems, and increase the reliability of care between multiple members of a care team are strong motivators to invest in high-tech solutions. In home-based care where services are typically provided by one nurse, aide, or therapist at a time, it is common to feel isolated and unsure when faced with an unexpected patient condition. This is even more challenging for hospice family caregivers, who are often alone when new conditions or symptoms arise, a condition which is multiplied in rural communities where the closest neighbor may be miles away. Responding to patient changes in these circumstances is limited by time, distance, and the ability to communicate. These conditions are not new and many consider them unchangeable, but technology offers new solutions for those willing to try.


Serving almost half of Iowa, HCI Care Services provides hospice care in sparsely populated areas where an hour commute between patient visits is standard. This geography is even more challenging during after-hours or in difficult weather. Seeking opportunities to improve connections with patients and families and reduce the response time when there are needs, a community grant from Telligen Corporation supported the addition of telehealth to the hospice resources.


In hospice, family caregivers are vital and typically overwhelmed. The enormity of caring for a loved one as they die evokes high levels of anxiety. The ability to connect with the hospice team when there is a change is critical. When patients are suffering, caregivers need help. The telephone has historically been the only mode for immediate connectivity. The communication between family and nurse during these times is often limited by the difficulty family and caregivers may have describing what is happening. Seeking to improve this communication, the ability for a video call was introduced. The goal of this pilot project was to provide quicker patient assessments; respond faster to patient need and reduce caregiver anxiety. Clinicians used Iphones(R) and offered patients and families the opportunity to have an Ipad(R) specially programmed to connect quickly and easily to the nurse on call. This system enabled the team to see what the caller was seeing. It was targeted for use when the caregiver was initiating a contact to supplement normal care, not to replace planned visits.


In the beginning, the project struggled with finding software that would meet cyber security needs and be functional in rural areas where cell phone service remains spotty. After resolving these issues, there were concerns families wouldn't be interested or welcoming of the device. This never happened. After introducing the equipment and explaining the process, no one turned down the opportunity. When it was used, both nurses and family reported high satisfaction with the call. Nurses reported that the ability to see the patient added a level of confidence to their assessments they had not had previously, making it easier to provide guidance. Families appreciated how easy it was to use and reported high satisfaction with the interaction. One unexpected result of the project was the realization that a high percentage of after-hours calls were from skilled nursing facilities. As a result, the team is now partnering to bring the technology to them as well.


Hospice services center on the high touch aspects of healthcare. Fear that technology will interrupt these relationships has hampered innovation. This example demonstrates that technology can be minimally disruptive to the care process and improves care when done with the intention to resolve barriers and with attention to results. It offers a path for hospice to innovate; approaching old problems with new solutions to care for people.


One in Three Prescriptions Was Unnecessary, Whereas Half of Respiratory Infection Prescriptions Were Inappropriate

Nearly one-third of the antibiotics prescribed in the United States aren't appropriate for the conditions being treated, a new federal government study shows. "We were able to conclude that at least 30 percent of the antibiotics that are given in doctors' offices, emergency departments and hospital-based clinics are unnecessary, meaning that no antibiotics were needed at all," said lead researcher Dr. Katherine Fleming-Dutra. Such misuse has helped fuel the rise of antibiotic-resistant bacteria, which infect 2 million Americans and kill 23,000 every year, said Fleming-Dutra, a pediatrician and epidemiologist at the U.S. Centers for Disease Control and Prevention. Antibiotics are most misused in the treatment of short-term respiratory conditions, such as colds, bronchitis, sore throats, and sinus and ear infections, the researchers reported. In this study, Fleming-Dutra and her colleagues analyzed more than 184,000 outpatient visits reported in a 2010-2011 national medical care survey. Of those sampled visits, nearly 13% resulted in antibiotic prescriptions. About 262 million outpatient antibiotic prescriptions were dispensed in 2011 in the United States, but until now no one knew how many of those prescriptions were inappropriate, she said. To assess misuse of antibiotics, the researchers relied on national treatment guidelines to look for conditions that should never be treated using antibiotics, such as the common cold, sore throats caused by viral infections, and bronchitis. The study findings were published in the May 3 issue of the Journal of the American Medical Association.

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