North Memorial Home Health and Hospice

is a hospital-based agency providing care for 500 to 525 patients daily. Based in Robbinsdale, Minnesota, the agency operates as a department of North Memorial Medical Center, a 518-bed Level I Trauma Center and certified primary stroke center. Through its participation in the Honeywell HomMed National Telehealth Value Study, North Memorial Home Health and Hospice was eager to explore how telemonitoring would enhance their efficiency and increase their current level of high quality care. Agency Director, Kathryn Wornson, Study Manager, Karen Persico, Case Manager, Gloria DeLong, and supervisor,

Chris Fagnan Olson, recently discussed North Memorial's experiences with telemonitoring.

Q.How Has Your Experience Changed Your Views On Telemonitoring?

We had been talking about telemonitoring and wanting to use it for years. We thought it presented a great opportunity and would prove to be of value. Our experience, during the study and after, is that telemonitoring can make a real difference in our patients' lives and in our ability to care for them. It gives us information - and information allows us better opportunities to do care and to work with doctors. It's the daily watching, tracking and trending of vital signs that telemonitoring provides that is important and encouraging.

Q.What Have You Learned About Telemonitoring's Role In Helping You Care For Patients?

Without telemonitoring, there would be no way we could get the kind of patient data that is now available to us. We would have to visit patients every day. During the study, we found, for example, that we could get excellent correlating vital signs data indicating a patient's response to medication. We also found that telemonitoring could immensely benefit three types of patients: CHF, cardiovascular disease and COPD. With the monitoring equipment in their homes, patients with these conditions were often able to identify their own needs. They could see the effects on how their bodies responded to their care plan. This was illustrated by one of our Stage 3 CHF patients, a gentleman who measured his vital signs twice a day and who, for weeks, had had no edema. Then one day, the data revealed that he had experienced swelling with the corresponding weight gain. When we called him to ask what he might have done to bring on this change, he remembered eating a bowl of canned chicken soup, which, of course, is high in salt. It was a learning moment for him - and for us. We can teach, but patient awareness really grows when the impact of their actions is right in front of them.

Q.What Has Been The Impact Of Telemonitoring On Patient And Family Satisfaction?

A number of our patients would cry if we talked about taking the telemonitoring equipment away. They believed it was a great benefit to know their vital signs and to know someone is watching. Most of the other patients were more easy-going. Their attitude was, "Nurse, if you think it's going to help, then I'm for it." We found that having telemonitoring equipment in the homes of our patients provided a sense of reassurance to patient and family members. Many learned how to identify their own needs as a result of monitoring their vitals.

Monitoring To Discern Next Steps

Our patient was on potent medications for hypertension. We were monitoring her two times a day - and the reports showed that the medications were not bringing her blood pressure down. We sent the report to her doctor and he increased her medications. When her blood pressure continued high, the doctor suspected that a kidney condition may be impairing circulation and contributing to the problem. Tests found an occluded renal artery. She received a stent and her blood pressure improved. It was through monitoring that we immediately found that the medication wasn't bringing her blood pressure down and that led to the next steps for the physician. Experiences like this sold me: What we can do with telemonitoring is important.

- Gloria DeLong, case manager

Source: Remington Report - August 2006