Telemonitoring Opportunities for Community Nursing
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Presented by Sheree East Director of Nursing, Nurse Maude
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Telemonitoring Opportunities for Community Nursing
- 1. Nurse Maude Taming Chronic Conditions and Improving Quality of Life Through Telemonitoring HINZ Conference Workshop 29 November 2013 Opportunities for a community nursing service Sheree East – Director of Nursing Nurse Maude Care in the heart of community care
- 2. Nurse Maude Services Self care support Avoid admission High Complexity Care Management Care Management Enable early discharge Delay entry into residential care Supportive Community care Care coordination Specialist Nursing & Allied Health Nurse Led Clinics District Nursing CREST Home Care Palliative care Long Term Care InterRAI assessment and referral management NASC Continence Infusion Case management Restorative Care Packages Tertiary Hospice Personal Care & Nursing Personal Care Domestic Assistance 40 bed hospital level aged care Stoma Wound Diabetes Dietetics Specialist Woundcare Generalist nursing Dialysis Support care Rapid Response Paediatrics School Health Specialist Community Team Liaison Education Acute Demand GP Liaison Telehealth Equipment Meals Laundry
- 4. 118 years of providing home-based services Nurse Maude in 2013: • 40% of clients over 85 years old • 55% Multiple comorbidities • 14,000 patients per annum • 750,000 episodes of care
- 5. Telehealth at Nurse Maude • Assistive technologies trial and learnings • Telemonitoring • Tool kit for clinicians Care in the heart of community care
- 6. The usability of an electronic medications dispenser in the context of the Nurse Maude Medications Management Service
- 7. Medications Management – “E-health” innovation 1. Alternative to blister packs. 2. Each ‘cell’ contains all the medications due each episode. 3. When pills are due, the internal tray rotates, an alarm sounds, and a red light flashes. 4. Medications tip from the slot into your hand or onto a plate to take them.
- 8. Client selection – range of conditions Likely to be beneficial for clients with: Less likely to be beneficial for clients with: Wish to comply with prescription Do not wish to comply with prescription Mild cognitive impairment (early dementia) Moderate cognitive impairment (moderate to severe dementia) Visual impairment Hearing impairment Short term memory loss Drug dependency Dexterity issues Severe dexterity issues Parkinson's Disease Long term conditions Frequent daily medications Adapted from McArthur (2008) and Hopkins (2005) Electronic medications management study 2013
- 9. Client selection – range of abilities Abilities needed to use (without support): Blister packed medications Electronic medications dispenser Medications concordance yes yes Remember meds regimen yes no Recognise medications due yes no Orientated to time/place yes no Recognise medications yes yes Be able to read labeling yes no Manual dexterity yes no Visual acuity yes yes Hearing acuity no yes Adapted from Hopkins (2005) Electronic medications management study 2013
- 10. Consumer feedback Benefits Previously felt disempowered by medications supervision visits Greater independence and control Ease of use Improved compliance with medications prescription Costs Lack of company Usability – acceptability More effective than medications supervision visits – reliability (always on time) Acceptable Usability systems and processes Problem solving was timely The e meds dispenser was right for them Communication was important to clients safety
- 11. Medications Carousel Benefits I can get up when it suits me Makes me feel small having someone say “take your pill” I wasn’t sure about dealing with a new thing like this – but it’s easy! (confidence) Low cost medications compliance. Reduced complications due to mismanaged medications I used to make a lot of mistakes and got in an awful mess
- 12. Health Professional feedback Benefits Increase efficiency / reduce cost Increase client independence Reduce workers exposure to errors Improve compliance Introduce innovation to clinical practice Costs Reluctance to embrace new technology Additional workload to select clients and establish set up Labelling Not being present in clients homes as often Sustainability Usability acceptability Benefits appear to outweigh costs Benefits for the client are central for Health Professionals Engagement and familiarity enhances acceptability Usability systems and processes Documentation works Client selection is key Communication between health professionals
- 13. Costs and benefits from the health professionals and clients perspectives Ease of use Increased efficiency and reduced cost Acceptable in the context of MMS Opportunity for innovation Felt disempowered by previous medications management Improved compliance MMS health professionals Greater independence and control MMS client Client selection key to success Reluctance to embrace technology Additional workload initially Ongoing support unsustainable Not being present in clients homes Communication key to safety Lack of company Labelling issue Electronic medications management study 2013
- 14. From assistive technology to Telemonitoring opportunities Diagnosis Nurse Maude patients in 2012 Hyper / Hypo tension 1951 Diabetes 1802 Circulatory 1098 Frail elderly 968 CVA/Stroke 844 Congestive Heart Failure (CHF) 672 COPD & emphysema 687 Dementia 476 Myocardial Infarction 304 Cardiac Surgery 192
- 15. Telemonitoring + Clinical Expertise = Wrap Around Care to High Risk Clients - Safely • • • • • • • • • Matching solution(s) to client need Integrated with existing service, oversight, back up Supporting people to accept more self care models Managing perceived barriers to client involvement Nurses as health service navigators Patient selection and support Home based model - teaching people in tool use Monitoring / response for high risk/complex people Graduated support - towards self management
- 16. Service Set Up and Management • • • • • • • • Make sure it works first! Decide technologies to use Identify people who will benefit Level of support tailored to the user Comprehensive support plan Impact on protocols and work flows Creating sustainability Managing system security and privacy
- 17. Workforce Development • • • • • • • • • • Role re-engineering Engaging staff so they in turn engage patients Embedding tools into routine practice Understanding educational requirements Development now to manage future demand Engaging clinicians with the use of technology Managing expectations Understanding uses, promoting practice innovation Integration into every day practice Tool Kit concept
- 18. Thank you Sheree East sheree@nursemaude.org.nz Care in the heart of community care