Telehealth and Medication Administration

Telehealth

• Telecommunication technologies are used to facilitate communication between providers and clients
• Methods include social media apps, video conferencing, and other media
• Purpose is to assess, diagnose, treat, and prevent diseases
• Benefits include increased access to healthcare by eliminating the need for travel

Medication Administration

• Medication administration process has five phases:
  • Medication Prescribing: Healthcare providers evaluate the patient and prescribe the appropriate medication
  • Transcription: Medication order is transcribed accurately into the patient's medical record
  • Preparing and Dispensing: Medication is prepared and dispensed by pharmacist or nurse
  • Administering: Nurse administers medication by the prescribed route and dosage
  • Monitoring and Follow-up: Nurse monitors the patient for desired therapeutic effects and adverse reactions, documenting the outcome
• Proper adherence to all phases is crucial for safe and effective medication administration

Medication Reconciliation

• Joint Commission (TJC) believes that medication reconciliation is important for patient safety in the ambulatory care setting
• Nurses and clients work together to confirm and document all of the client's current medications when they are admitted to the healthcare institution
• TJC's 2024 National Patient Safety Goals (NPSG) include NPSG 3: Improve the safety of using medications

Electronic Health Records (EHR)

• Proven to have great benefits, but there can be legal ramifications if documentation is incomplete or inaccurate
• Components of medical records can be used as evidence in a court of law
• Nurses must adhere to the ANA's standards which require documentation to be factual, accurate, complete, timely, organized, and compliant
• Nurses need to be aware of state and federal regulations, health care facility policies, and their professional obligations to ensure documentation is accurate
• Challenges include:
  • High implementation and maintenance costs
  • Workflow disruptions and productivity loss during transition from paper records
  • System interoperability issues
  • User training and resistance to change
  • Concerns over data privacy, security breaches, and patient confidentiality
  • Alert fatigue
  • Potential for documentation errors
  • Time required for data entry

Remote Patient Monitoring (RPM)

• Involves using digital technologies to collect and transmit patient health data from their home or other location to healthcare providers
• Key aspects of RPM include:
  • Wearable or implantable biosensors that continuously track vital signs
  • Mobile apps and connected devices that allow patients to report symptoms and treatment adherence
  • Secure transmission of patient data to their care team
  • Analysis of the data by providers to monitor disease progression and adjust treatment plans
  • Two-way communication between patients and providers
• RPM enables more proactive and personalized care for patients with chronic conditions, reduces hospital admissions, and empowers patients to take an active role in self-management

Electronic Monitoring Devices

• RPM is assisted by the use of mobile medical devices, sensors, and technology
• Information is collected and transferred through wired or wireless devices
• Data includes:
  • Heart rhythm
  • Vital signs
  • Blood oxygen saturation level
  • Blood glucose level
• Monitors can also detect motion or transmit real-time video
• Sensors can be placed in clothes or elastic bands directly attached to a client's body
• Devices can be used for real-time monitoring in detecting client falls and assessing gait, activity, and sleep patterns
• Some RPM devices include the ability to:
  • Link clients to their health records
  • Provide educational resources and interactive self-care tools
  • Connect the client to their health care provider

Patient-Generated Health Data (PGHD)

• RPM devices permit clients to produce PGHD
• PGHD includes:
  • Client health history
  • Bodily measurements
  • Symptoms
  • Individual behavioral factors
• Clients are better able to manage their health and be active participants in their healthcare through RPM

Health Literacy:

• Focus of Healthy People 2030
• Defines health literacy as:
  • Personal health literacy: An individual's ability to understand and use health information
  • Organizational health literacy: The extent to which organizations equitably assist people with understanding, finding, and using information and services to make informed health-related decisions

Electronic Documentation

• Often used as a means of communication among health care providers
• Advantages include:
  • Increased legibility
  • Technical support compared to handwritten records
  • Potential cost savings from reduced paperwork and improved efficiency

Documentation During EHR Downtime

• EHRs can experience downtimes
• Events can be planned or unexpected
• Downtimes can be disruptive to client care
• Nurses must be aware of their facility's procedures for managing events
• Documentation still needs to occur during downtime
• Healthcare providers often switch to paper documentation during downtime

Documentation Methods

• Several different systems can be used for documenting client information
• The system used depends on the facility
• Methods include:
  • Charting by exception
  • Problem-oriented medical records (POMR)
  • Source-oriented records
  • Problem, Intervention, Evaluation (PIE)
  • Focus charting
  • Electronic health records (EHRs)

PIE Model

• Simplified approach to documentation that uses flowsheets and progress notes
• Focuses on the nursing process and includes an ongoing plan of care
• Problem is defined using a nursing diagnosis
• Information is collected from the client, caregiver, or family member
• Includes three components:
  • P: Problem: Nursing diagnosis
  • I: Interventions: Nursing actions
  • E: Evaluation: Evaluation of efficacy of interventions
• The example in the text shows Objective data under "O"

Focus Charting

• Focuses on client's specific health care problem by focusing on the nursing diagnosis
• Documents changes in a client's condition, events, and concerns
• Three essential components:
  • D: Data: Factual data about the client's condition
  • A: Action: Nursing actions taken in response to the data
  • R: Response: Client's response to the nursing actions
• Includes immediate and future nursing actions.