A nurse-led implantable loop recorder service is safe and cost effective.

INTRODUCTION: Implantable loop recorders (ILR) are predominantly implanted by cardiologists in the catheter laboratory. We developed a nurse-delivered service for the implantation of LINQ (Medtronic; Minnesota) ILRs in the outpatient setting. This study compared the safety and cost-effectiveness of the introduction of this nurse-delivered ILR service with contemporaneous physician-led procedures. METHODS: Consecutive patients undergoing an ILR at our institution between 1st July 2016 and 4th June 2018 were included. Data were prospectively entered into a computerized database, which was retrospectively analyzed. RESULTS: A total of 475 patients underwent ILR implantation, 271 (57%) of these were implanted by physicians in the catheter laboratory and 204 (43%) by nurses in the outpatient setting. Six complications occurred in physician-implants and two in nurse-implants (P = .3). Procedural time for physician-implants (13.4 ± 8.0 minutes) and nurse-implants (14.2 ± 10.1 minutes) were comparable (P = .98). The procedural cost was estimated as £576.02 for physician-implants against £279.95 with nurse-implants, equating to a 57.3% cost reduction. In our center, the total cost of ILR implantation in the catheter laboratory by physicians was £10 513.13 p.a. vs £6661.55 p.a. with a nurse-delivered model. When overheads for running, cleaning, and maintaining were accounted for, we estimated a saving of £68 685.75 was performed by moving to a nurse-delivered model for ILR implants. Over 133 catheter laboratory and implanting physician hours were saved and utilized for other more complex procedures. CONCLUSION: ILR implantation in the outpatient setting by suitably trained nurses is safe and leads to significant financial savings.

Detection and management of atrial fibrillation using remote monitoring.

Atrial fibrillation (AF) is the most common dysrhythmia encountered in the United States. Symptoms may be similar to those of other cardiac conditions, which can delay the timely detection, diagnosis, and management of AF. This article provides an overview of AF and modalities used in remote monitoring.

[Telemonitoring by the nurse of patients equipped with an implantable heart device]. / Télésuivi par l'infirmière des patients porteurs d'un dispositif cardiaque implantable.

The nurse is at the heart of the caregiving relationship in the remote monitoring of patients with heart failure equipped with an implantable device. Her direct contact with the patient erases the distance imposed by telemonitoring and her close connection with the cardiologist-arrhythmia specialist ensures the patient follow-up is optimal. After her training in telemedicine, the nurse plays a key role in the telerhythmology activity.

Nurse perspectives on the implementation of routine telemonitoring for high-risk diabetes patients in a primary care setting.

Aims The purpose of this qualitative evaluation was to explore the experience of implementing routine telemonitoring (TM) in real-world primary care settings from the perspective of those delivering the intervention; namely the TM staff, and report on lessons learned that could inform future projects of this type. BACKGROUND: Routine TM for high-risk patients within primary care practices may help improve chronic disease control and reduce complications, including unnecessary hospital admissions. However, little is known about how to integrate routine TM in busy primary care practices. A TM pilot for diabetic patients was attempted in six primary care practices as part of the Beacon Community in Western New York. METHODS: Semi-structured interviews were conducted with representatives of three TM agencies (n=8) participating in the pilot. Interviews were conducted over the phone or in person and lasted ~30 min. Interviews were audio-taped and transcribed. Analysis was conducted using immersion-crystallization to identify themes. Findings TM staff revealed several themes related to the experience of delivering TM in real-world primary care: (1) the nurse-patient relationship is central to a successful TM experience, (2) TM is a useful tool for understanding socio-economic context and its impact on patients' health, (3) TM staff anecdotally report important potential impacts on patient health, and (4) integrating TM into primary care practices needs to be planned carefully. CONCLUSIONS: This qualitative study identified challenges and unexpected benefits that might inform future efforts. Communication and integration between the TM agency and the practice, including the designation of a point person within the office to coordinate TM and help address the broader contextual needs of patients, are important considerations for future implementation. The role of the TM nurse in developing trust with patients and uncovering the social and economic context within which patients manage their diabetes was an unexpected benefit.

A Review of Worldwide Patents: Innovations in Peak Flow Meters for Asthma.

BACKGROUND: Contemporary healthcare nurses increasingly rely on innovative technology for assessment, treatment, and patient self-management. Funding opportunities as well are increasingly steering toward technology development and innovation. Health researchers, including nursing scientists, who are engaged in medical device innovation need to assess the state of the art of current technology. This requires an intellectual property analysis, or patent search, which is not covered by the types of literature reviews customarily used in health science research. PURPOSE: The purposes of this article are to illustrate a methodical review of worldwide patents and to show how those results can be used to identify possible products available for use. APPROACH: An application of peak flow meters for use by patients with asthma is used to illustrate the process. The Derwent Innovations Index interface with keyword searching is illustrated, as is the use of Google Patents. From the 14 patent document results, six possible technologies were identified. The patent search revealed innovations in asthma peak flow meters for use in future research and identified future directions for device development. DISCUSSION: These results support the claim that patent literature must be included in reviews that seek to identify technology state-of-the-art healthcare applications and that advances in the nursing research paradigm should include patents as background and scholarly products.

Impacto do monitoramento telefônico na avaliação do conhecimento e autocuidado de pacientes com insuficiência cardíaca / Impact of telephone monitoring in the evaluation of knowledge and self-care of patients with heart failure

Introdução: O seguimento clínico multidisciplinar dos pacientes com IC crônica melhora o autocuidado, o conhecimento sobre a doença, bem como efeitos benéficos na adesão ao tratamento, redução no número de hospitalização e custos hospitalares, cabendo ao enfermeiro, um papel crucial na educação em saúde ao paciente/família e a monitorização contínua destas ações. Objetivos: Analisar o autocuidado e o conhecimento sobre a IC no monitoramento ambulatorial convencional comparado com a mesma estratégia associada a uma abordagem telefônica pela enfermagem; Comparar os escores do conhecimento sobre a IC e o autocuidado na IC; Analisar a associação das variáveis de conhecimento com o autocuidado na IC. Método: Ensaio Clínico Randomizado. A amostra foi composta por 36 participantes alocados no Grupo Controle (GC) ou no Grupo Intervenção (GI). Ambos os grupos foram monitorados na clínica de IC/HUPE durante 4 meses (tempos: 0, 2, 4 meses), realizando o tratamento convencional. No entanto, o tratamento no GI foi associado ao monitoramento telefônico, totalizando entre 7 a 10 ligações durante todo período. Para avaliar os desfechos propostos, dois enfermeiros participaram da coleta de dados, utilizando questionários adaptados e validados para uso no Brasil, de conhecimento (Questionário de Conhecimento sobre a IC) e autocuidado (Questionário EHFScBS), obtendo seus escores totais para análise dos dados. Resultados: No GI 19 participantes completaram o estudo, enquanto no GC, 17. Foi evidenciado, na caracterização da amostra, em ambos os grupos, NYHA (I, II e III) e FEVE (≤50%). Comparando o GI vs. GC: idade 60,5±12,3 vs. 60±10,9; sexo masculino 52,6% vs. 47,4%. Não houve diferença significativa nas características da amostra (sociodemográfico, hemodinâmico cardiovascular e antropométrico) (P>0,05); houve diferença significativa no conhecimento (12,7±1,7 vs. 10,8±2,2; P=0,009) e autocuidado (25,4±6,6 vs. 29,5±4,8; P=0,04) no 4º mês.

Introduction: The multidisciplinary clinical follow-up of patients with chronic HF improves self-care, knowledge about the disease, as well as beneficial effects on treatment adherence, reducing the number of hospital stay and hospital costs, being the nurse, a crucial role in health education the patient/family and the continuous monitoring of these actions. Objectives: To analyze self-care and knowledge of the HF in the conventional outpatient monitoring compared to the same strategy associated with a telephone approach for nursing; Compare the scores of knowledge about HF and self-care in HF; To assess the association of knowledge variables with HF patients. Method: Randomized Clinical Trial. The sample consisted of 36 participants allocated to the control group (CG) or the intervention group (IG). Both groups were monitored in clinical HF/HUPE for 4 months (time 0, 2, 4 months), performing conventional treatment. However, treatment was associated with IG telephone monitoring a total of from 7 to 10 links throughout the period. To evaluate the proposed outcomes, two nurses participated in data collection, using questionnaires adapted and validated for use in Brazil, knowledge (Knowledge Questionnaire HF) and self-care (Questionnaire EHFScBS), getting your total scores for data analysis. Results: In IG 19 participants completed the study while at the CG, 17. It was shown in the characterization of the sample, in both groups, NYHA (I, II and III) and LVEF (≤50%). Comparing IG vs. CG: age 60,5±12,3 vs. 60±10,9; male 52,6% vs. 47,4%. No significant differences in sample characteristics (sociodemographic, anthropometric and cardiovascular hemodynamic) (P>0,05); was no significant difference in knowledge (12,7±1,7 vs. 10,8±2,2; P=0,009) and self-care (25,4±6,6 vs. 29,5±4,8; P=0,04) in the 4th month.

Time-motion analysis of research nurse activities in a lung transplant home monitoring study.

BACKGROUND: The emergence and subsequent integration of new technologies precipitate changes in roles and work lives of nurses. The nurses' work with home monitoring technologies within a spirometry-based program that transmits pulmonary function data after lung transplantation has characteristics that are distinct from other types of direct patient care. Nurses' changing roles in such programs after transplantation have not been well described. OBJECTIVE: To describe a time-motion study of 2 research nurses in the context of a home-spirometry study to monitor patients' pulmonary status after lung transplantation. METHOD: A detailed list of research nurses' 67 routine work-related activities was developed and validated to monitor and record activities of research home monitoring nurses. Two weeks of observations were completed; recordings of a second observer established reliability of observations. RESULTS: In 48.8 hours of observation, 610 tasks related to monitoring of 45 patients were recorded. Task time ranged from brief seconds (eg, data review) to 39 minutes (eg, clinic visits). Between-observer intraclass correlation (r = 0.96) reflected high agreement in observations of the duration of activities. Agreement for category of activity was strong (kappa = 0.82), with high levels of agreement (96%). Computer tasks were the most frequent (118 tasks/week) and most time-intensive activities. Nurses' face-to-face interactions with health professionals were equally time intensive (both 267 minutes/week), but not as frequent. Data review tasks were the second most frequent (49/week), although less time-intensive (47 minutes/week). CONCLUSION: Findings reveal patterns of effort and time expenditure in nurses' evolving roles in home monitoring of the health status of patients after lung transplantation. These findings highlight the centrality and importance of well-developed data management, computer skills, and interprofessional communication skills of nurses who perform responsibilities in this emerging role in transplantation. Efforts to streamline computerized information access, as through integrated information systems, and methods to enhance efficiency in connecting with patients in the clinic may free up time for nurses to engage in other activities of direct benefit to patients. Strategies to supplement face-to-face meetings among professionals with electronic modalities may reduce the time spent meeting, while maintaining or enhancing communication.

Exploring the translational impact of a home telemonitoring intervention using time-motion study.

OBJECTIVE: Home telemonitoring improves clinical outcomes but can generate large amounts of data. Automating data surveillance with clinical decision support could reduce the impact of translating these systems to clinical settings. We utilized time-motion methodology to measure the time spent on activities monitoring subjects in the two groups of a home spirometry telemonitoring randomized controlled trial: the manual nurse review (control) group and the automated review (intervention) group. These results are examined for potential workflow effects that could occur when the intervention translates to a clinical setting. MATERIALS AND METHODS: Time motion is an established industrial engineering technique used to evaluate workflow by measuring the time of predefined, discrete tasks. Data were collected via direct observation of two research nurses by a single observer using the repetitive or snap-back timing method. All observed tasks were coded using a list of work activities defined and validated in an earlier study. Reliability data were collected during a 2-h session with a secondary observer. RESULTS: Reliability of the primary observer was established. During 35 h of data collection, a sample of 938 task observations were recorded and coded using 46 previously defined and 5 newly defined work activities. Between-group comparisons of activity time for subjects in the two study groups showed significantly more time spent on data review activities for the automated review group. Reclassification of the 51 observed activities identified 15 activities that would translate to a clinical setting, of which 5 represent potentially new activities. CONCLUSIONS: Implementing an intervention into a clinical setting could add work activities to the clinical workflow. Time-motion study of research personnel working with new clinical interventions provides a template for evaluating the workflow impact of these interventions prior to translation from a research to a clinical setting.

Developing a comprehensive electronic health record to enhance nursing care coordination, use of technology, and research.

As in acute care, use of health information technology in long-term care holds promise for increased efficiency, better accuracy, reduced costs, and improved outcomes. A comprehensive electronic health record (EHR), which encompasses all health care measures that clinicians want to use-both standard health care assessments and those acquired through emerging technology-is the key to improved, efficient clinical decision making. New technologies using sensors to passively monitor older adults at home are being developed and are commercially available. However, integrating the clinical information systems with passive monitoring data so that clinical decision making is enhanced and patient records are complete is challenging. Researchers at the University of Missouri (MU) are developing a comprehensive EHR to: (a) enhance nursing care coordination at TigerPlace, independent senior housing that helps residents age in place; (b) integrate clinical data and data from new technology; and (c) advance technology and clinical research.

Device diagnostics for heart failure: identifying eligible patients.

The prevalence of heart failure has increased by 500% over the past 30 years, creating a significant burden on the health care system. Traditional means of detecting worsening heart failure, such as subjective assessment, symptoms, and physical examination, lack sensitivity and specificity. Many nurses who manage heart failure patients have become interested in the role implantable cardiac devices play in monitoring patients' clinical status. In addition to providing therapies, some devices track and report diagnostic information that allows clinicians to more closely and effectively monitor patients, with the possibility of helping to prevent hospitalizations and improve patient outcomes. Optimal use of device diagnostics requires clinics to establish systems for recognizing patients who are eligible for device monitoring. This paper highlights various methods clinics have used to identify patients with implantable cardiac devices so that their device data can be used in conjunction with clinical evaluations to help guide patient care.

Impact of telehealth on clinical outcomes in patients with heart failure.

The purpose of this randomized field study was to determine the effects of telehomecare on hospitalization, emergency department (ED) use, mortality, and symptoms related to sodium and fluid intake, medication use, and physical activity. The sample consists of 284 patients with heart failure. The authors used logistic regression to study the effects of telehomecare on health services utilization and mortality and a general linear model to analyze changes in self-reported symptoms. On average, patients in the telehomecare groups had a lower probability of hospitalizations and ED visits than did patients in the control group. Differences were statistically significant at 60 days but not 120 days. Results show a greater reduction in symptoms for patients using telehomecare compared to control patients. The technology enables frequent monitoring of clinical indices and permits the home health care nurse to detect changes in cardiac status and intervene when necessary.

Implementing a home telemonitoring program.

In the current healthcare arena, it is imperative that home healthcare agencies seek to reduce costs and produce positive outcomes from the care they give. Telemonitoring offers the ability to monitor closely the daily status of the patients that home healthcare agencies serve, to provide best practice care, and to produce positive outcomes from that care. This article presents the experience of how 1 hospital-based agency implemented a home telemonitoring program and describes the lessons learned throughout the process. The current healthcare arena demands cost reduction and improved patient care outcomes from home healthcare agencies (HHAs). The direction that each HHA chooses to take to answer these demands will set the stage for their future. This article describes the steps needed to implement a telemonitoring program. The description is based on how 1 HHA chose its course of action and set it in motion and shows what was learned throughout the process.

Telenursing and home healthcare. the many facets of technology.

Telenursing was instituted as an effective mode for providing care to patients geographically distant from healthcare providers. Using telecommunications and information technology, nursing care is provided remotely to individuals. Nurses recognize the value of telecare and telehomecare as essential components of telenursing that give patients easy access to high-quality care and eliminate costs and difficulties associated with travel to healthcare facilities. Patient satisfaction with telenursing is related to prompt quality care from professional nurses. Telenursing continues to grow as a valuable method for providing nursing care, especially in home healthcare.

Telemonitoring of heart failure patients and their caregivers: a pilot randomized controlled trial.

Heart failure (HF) is the leading cause of rehospitalization in older adults. The purpose of this pilot study was to examine whether telemonitoring by an advanced practice nurse reduced subsequent hospital readmissions, emergency department visits, costs, and risk of hospital readmission for patients with HF. One hundred two patient/caregiver dyads were randomized into 2 groups postdischarge; 84 dyads completed the study. Hospital readmissions, emergency department visits, costs, and days to readmission were abstracted from medical records. Participants were interviewed soon after discharge and 3 months later about effects of telemonitoring on depressive symptoms, quality of life, and caregiver mastery. There were no significant differences due to telemonitoring for any outcomes. Caregiver mastery, informal social support, and electronic home monitoring were not significant predictors for risk of hospital readmission. Further studies should address the interaction between the advanced practice nurse and follow-up intervention with telemonitoring of patients with HF to better target those who are most likely to benefit.

Teaching your patient to use a peak flowmeter.

Monitoring peak expiratory flow rates and keeping a daily diary can help him manage his asthma better.

Naúseas y vómitos postoperatorios en cirugía ambulatoria / Post-operative nause and vomiting in Ambulatory Surgery

Las náuseas y vómitos postoperatorios se incluyen entre las experiencias más desagradables que puede presentar un paciente, y constituyen uno de los motivos con mayor impacto negativo en la satisfacción global dentro del conjunto de la experiencia (..) (AU)

Post-operative nausea and vomiting are amongst the most disagreeable symptoms patients can experience and are one of the main negative reasons for patient's discontent with the surgical procedure. Despite the advances (..) (AU)

A pilot study of nurse-led, home-based telecardiology for patients with chronic heart failure.

We assessed the feasibility of home-based telecardiology for patients with chronic heart failure (CHF). Seventy-four CHF patients were enrolled into a programme of telephone follow-up and single-lead electrocardiography (ECG) monitoring. The patients transmitted their ECG data by fixed telephone line to a receiving station, where a nurse was available for an interactive teleconsultation. Patients were followed up for a mean (SD) of 307 (108) days; 1467 calls were analysed (213 ad hoc consultations and 1254 scheduled consultations). A total of 124 cardiovascular events were recorded. Modifications to therapy were suggested in response to 119 calls; hospital admissions were suggested for 13 patients, further investigations for 7 and a consultation with the patient's general practitioner for 13. No action was taken after 1330 calls. Twenty-two ECG abnormalities were recorded. In 63 patients receiving the beta-blocker carvedilol, the mean dosage increased from 36 to 42 mg. In the previous year there were 1.8 hospitalizations per patient, while in the follow-up period there were 0.2 hospitalizations per patient. Following up CHF patients using a nurse-led telecardiology programme seems to be feasible and useful.