Remote Control

Remote cardiac monitoring systems are appropriate for patients with a variety of conditions, such as congestive heart failure, COPD, diabetes, coronary artery disease and hypertension.

"Any alteration in the normal  functioning of a system in the human body has an effect on the heart," said Gail Sussman, BSN, RN, director of patients services, Visiting Nurse Association of Long Island (VNA of LI), Garden City, NY.

How It Works

Patients use the cardiac monitoring system at a specific time each day, "usually in the morning, so nurses have time to monitor results and intervene during the day if necessary," Sussman said. The machine talks patients through every step of the process, such as stepping on and off the scale and putting on the blood pressure cuff.

A home care nurse programs the machine to ask patients questions that pertain to their specific health concerns. For example, a nurse could program the system to ask, "Have you fallen in the past 24 hours?"

courtesy Kyle Kielinski

Once monitoring is complete, nurses receive a readout showing whether a patient is in the acceptable range, as determined by the patient's physician, for measurements such as weight, blood pressure, pulse oximetry, blood glucose and heart rate.

Getting this information on a daily basis "allows nurses to personalize the care plan for the patient. We are also able to coordinate with the patient's doctor to, for example, adjust a medication, without the patient having to go in for a visit," said Angella Colley, RN, COC, a home care nurse with First to Care Home Care Inc., a joint venture between MJHS, New York, and Maimonides Medical Center, Brooklyn.

Empowering Patients & Nurses

Although monitoring patients is an integral part of the home care nurses' role, what Colley enjoys most is the ability to educate patients and family members. "We educate the patient on the disease process, medications and diet, which brings a positive result," she said.

"Clients become much more invested in their health," said Cathy Pistone, BSN, RN, director of community relations for VNA of LI and a former home care nurse. "If they eat Chinese food for dinner, they can see the increase in blood pressure and weight the next day," and they start making healthier choices.

REWARDING NURSING JOB: "One of the very best rewards is to see a patient who starts out without any control over their medical management gain full control," said Angella Colley, RN, COC. "They become empowered to take charge of their health. They are excited to show you their results when you visit." courtesy Kyle Kielinski

Pistone believes telehealth leads to satisfaction for nurses because of the direct impact they have on patients' lives. "I felt connected to my patients on a much deeper level because I had more contact with them and I was able to get involved in intensive teaching."

"One of the very best rewards is to see a patient who starts out without any control over their medical management gain full control," Colley said. "They become empowered to take charge of their health. They are excited to show you their results when you visit."

Peace of Mind

CLOSEBY CARE: Telehealth monitoring systems allow the patient to go through a series of tests every day, so homecare nurses know exactly what is going on with their patient's health. When Angella Colley, RN, COC, is in a patient's home she educates them about the system and the disease process, as well as prepares medication for the patient, as she does with Yetta Medjuck. courtesy Kyle Kielinski

Carla Giugno, BSN, RN, vice president of clinical operations, Visiting Nurse Association of South Central Connecticut, New Haven, agrees: Patients feel empowered using telemonitoring systems.

"Patients have to be willing to accept the system," she said. "The patients who do the best are the ones who take it seriously.

"Telemonitoring allows us to be more efficient [with healthcare dollars] and to help prevent rehospitalization," Giugno added.

This was the case with Robert Soule of West Haven, CT, a patient of Jennie Cruz, LPN. He had multiple hospitalizations related to congestive heart failure in the year before he started telemonitoring. During the year the patient had the system in his home, he did not need to be hospitalized at all. In fact, his health has been restored to the point where he longer needs to rely on telemonitoring.

"The patients use the system in the morning, and it just becomes part of their daily routine," Cruz explained. "Many of the patients like the process of checking in with the telemonitoring system. It gives them a sense a reassurance that someone is checking in on them without the hassle and expense of going to a doctor's office."

TEACHABLE MOMENT: Angella Colley, RN, COC, walks her patient Kwong Han Tsang through the steps needed to complete blood pressure monitoring on his telehealth monitoring system. courtesy MJHS

For Soule's part, he really enjoyed using the telemonitoring system. He felt more invested in his healthcare, and it gave his wife peace of mind.

Reducing Healthcare Costs

Most ED visits tend to end in hospitalization, Colley points out.

"If we don't want the same patient constantly revolving in and out of the system, we need to monitor the patient and give the patient control over his condition," she said. This means noting trends in a patient's health, such as rising blood pressure or weight, and addressing those trends before they lead to an emergency.

"Telehealth reduces costs by saving ED visits, hospitalization and physician office visits," Sussman agreed. "I believe the future of telehealth will only grow and expand in today's healthcare arena."

But, said Sussman, it's important to remember while telehealth can save the health system money, the ultimate goal is to keep the patient healthy and at home. With remote cardiac monitoring, both goals can be accomplished simultaneously. 

Diana Friedman is regional editor at ADVANCE.