Before the Program
Luann Boettler, Martha’s Case Manager, placed a HomMed monitoring system in Martha’s home right away. The monitor was set to go off at the same times throughout each day, allowing Martha and Mays to track and trend her vital signs on a daily basis. Seeing Martha’s weight, blood pressure, heart rate, and blood oxygen levels daily allowed Luann to catch exacerbations in Martha’s conditions much sooner. As a result, more complex complications could be avoided by early intervention, which is exactly what happened. Martha was now avoiding what was previously an inevitable result; a costly hospital stay. “This machine has kept me out of the hospital. Prior to this, I was in the hospital four to six times a year,” says Martha. The HomMed Monitoring System was having another positive effect on Martha’s life. By seeing how her own choices were affecting her daily vital signs, the monitor was motivating her to take a proactive stance on her own health. “The monitor helps me keep up on my own health. It lets me know when I need to get in touch with the doctor so that we can change things if need be,” says Martha.
HomeCall’s CHF Program Is Introduced
Although Martha had avoided the hospital for several months, exacerbations of her CHF were still happening routinely. This situation was not tolerable for Mays, and the development of a solution had already been in the works. During May of 2005, Mays introduced its CHF program aimed at unstable CHF patients and “frequent flyers”. Martha’s condition definitely qualified her for the program. Martha’s doctor signed on, the desired parameters were set, and the medication kit included in the CHF program was placed in Martha’s home. Now Luann could administer the proper care to counter any undesired changes of Martha’s vital signs much quicker than before. Time is critical, with a matter of hours being the difference between staying home and another visit to the hospital. Now, with just a phone call from Luann, Martha could instantly take the medication needed to impede an exacerbation and be closely monitored until the desired effects are achieved. If needed, each step of the program could be administered without delay. “All I have to do is get on the monitor and do my vital signs and answer the questions and the nurses will call me and find out what is going on or come over. They will also come late at night. I know this first hand and the nurses take care of the problem,” states Martha. The CHF program also took Martha’s proactive stance towards her health a step further. Having the medication kit in the home gave Martha a “hands on” approach to working with the nurses in taking the timely and necessary actions for her health. The kit represented another means of success over her CHF. “The CHF program really empowers patients to take control of their own health,” says Luann Boettler. “It makes them a team player.”
Positive Effects of the CHF Program
Martha gained numerous benefits from Mays CHF program and her choice to take responsibility for her own health. She avoided the hospital for thirteen months, even then being admitted for reasons unrelated to her CHF. She has also lost 23 lbs. since being on the program. Martha also enjoys feeling better and making health-conscious choices. But the greatest benefit of all is having more control of her life. The HomMed monitor and the CHF program motivated Martha to take responsibility, showing her that lifestyle choices do directly affect one’s health. “In my opinion, the monitor has helped me stay out of the hospital many a time. I think the monitor has helped me in the long haul; it’s a very good thing.”
Following one particularly bad infection, she spent four days in the hospital recovering on IV antibiotics. She was finally discharged with a script for oral anti-biotic and was receiving home health services from Mays. Vicki Shirley, RN, acted quickly to put one of Mays HomMed telemonitors in her home to help keep a closer eye on Wilma’s condition. The telemonitor is used to measure a patient’s vital signs and send them on to the nurse within minutes.
Within a few days of using the telemonitor, Vicki noticed that Wilma’s oxygen levels were falling and that she was becoming hypotensive. Vicki immediately called to check on Wilma and discovered that the reason her vital signs had fallen so quickly was because she was not taking the medication prescribed for her. Wilma could not afford the costly pharmaceutical bill and had not informed Vicki about the situation. Vicki went directly to the doctor’s office and gathered samples of the drugs for her. The doctor, concerned with Wilma’s status, recommended that she go back to the hospital and stay in intensive care so she could be watched more closely. Wilma refused to go back to the hospital and begged to stay at home. Vicki and the doctor decided that since the HomMed telemonitor would allow Wilma to be monitored everyday, several times per day, they could try to keep her at home and see if her condition improved after she began her medication. This would allow Wilma the comfort of being in her own home, and provide her the attention she needed without having another stay in the hospital with a huge bill to deal with later. She began her medication and both Vicki and Wilma’s family used the telemonitoring system to keep a close eye on Wilma’s condition. Wilma’s family monitored here blood pressure and oxygen levels every 2-3 hours and reported the results to Vicki.
Within 48 hours of beginning the antibiotic, the monitor showed that Wilma’s blood pressure and oxygen levels were improving. By Monday, Wilma’s vital signs were back to normal and Vicki went to see the doctor to discuss Wilma’s status. After reviewing reports compiled by the telemonitor, the doctor was very impressed to see the turn around in her status. The monitor was crucial to discovering that Wilma was septic because other than her decreasing oxygen and blood pressure levels, there were no other symptoms that Vicki could have picked up on such as fever, chilling, or unconsciousness–which are common. The monitor had successfully enabled Vicki to see the initial downturn in Wilma’s status and to take immediate action to correct it without another costly hospital stay.
GETTING STARTED ON THE TELEMONITOR
Initially, Glenn was in denial about how serious his condition actually was, and did very little to improve his health. For example, he did not always take his medications as prescribed. Immediately upon his start of care, his Case Manager, Luann Boettler, RN, placed the Honeywell HomMed monitor in his home. She programmed the monitor to go off at 8:00 every morning in order to catch anything that might be wrong, and allow for adequate time to handle the situation. His blood pressure, heart rate, weight, and oxygen levels were all carefully monitored.
USING THE MONITOR TO PROMOTE PROPER HEALTH CARE
Over the course of Glenn’s home health care, the monitor provided an alert to several potential health problems. One instance was an overnight weight gain of 8 pounds, and a “yes” response to the monitor question, “Have your ankles been more swollen than usual?” His nurse, SueMae Bertenshaw, RN, called immediately and discovered he had celebrated his nephew’s birthday by eating a salty meal the night before. An extra skilled nursing visit was scheduled that morning. His legs were swollen to his knees, and he was having great difficulty breathing- even with oxygen. SueMae instructed him to make a doctor’s appointment before she left, telling him, “you are the one needing to make responsible choices for your health.” Glenn eventually agreed. “There were two times, where overnight, I had gained 5-10 pounds, and it was because of what I had eaten the night before. I decided then that pizza was no longer in my diet.” After seeing the direct effect of his salt intake, it was easier to convince Glenn of the importance of a healthy diet. He said, “Several visits later, Sue Mae looked through my cabinets in order to teach me the proper foods to eat. I surprised her by having some low-salt foods on my shelves.”
Seeing his daily blood pressure and heart rate readings, Glenn began to take his medications properly. His diuretic was adjusted twice by his physician, without making any unscheduled nursing or doctor visits. He also suffers from sleep apnea. “The monitor was also a big help in looking at my oxygen levels, and as a result I now use my bi-PAP at night.” The bi-PAP is equipment that uses positive airway pressure to trigger inspirations during brief episodes of non-breathing. His doctor had already ordered the use of the bi-PAP, but until he used the monitor to check his oxygen levels he hadn’t properly used it.
POSITIVE EFFECTS OF THE MONITOR
Upon discharge, Glenn was capable of understanding the information provided by the monitor and how he needed to take an active role in his own health care. By his last nursing visit, he had already purchased his own set of scales as well as his own pulse oximeter and blood pressure machine, knowing he could now manage his health without a nurse. The effects of his well-managed care have given him a new lease on life, as well as relieved the stress of dealing with illness and hospitalizations for both him and his family.