Remote Collaboration and Evidenced-Based Care Transcript

Remote Collaboration and Evidenced-Based Care Transcript

Welcome to my presentation regarding Remote Collaboration and Evidence-Based Care. My name is Julie Van Meter. Today I will be discussing how remote collaboration will assist in the care and long-term treatment of a newly diagnosed patient who does not have easy access to specialized medical resources due to distance. I will also develop an evidenced based plan of care based upon the utilization of remote learning.

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Caitlyn Bergan is a two-year old girl with a second admission within the last 6 months with the diagnosis of pneumonia. During this hospitalization, she was diagnosed with cystic fibrosis. The diagnosis was a result of an observation by her mother, Janice, that Caitlyn’s skin tasted salty after a kiss. Further conversation reveals that Caitlyn experienced a meconium ileus shortly after birth, has thick mucus secretions and exhibits signs of malabsorption. Upon admission, Caitlyn was assessed to weigh 20.7 pounds as a result of the malabsorption, decreased breath sounds and rhonchi with shallow respirations of 32 and a temperature of 101 degrees. Involved in Caitlyn’s care is Dr. Copeland, Pediatrician, Virginia Anderson, Pediatric Nurse, and Rebecca Helgo, Respiratory Therapist, who all have to collaborate in the care of Caitlyn. Dr. Copeland and Virginia, also collaborate with Dr. Benjamin, Caitlyn’s primary care physician. Collaboration is needed in the care of Caitlyn, but is made difficult due to the distance the patient lives from the specialty hospital and Dr. Benjamin does not have access to telemedicine. Virginia and Dr. Copeland meet with Dr. Benjamin to map out a plan for collaborative care. Skype was determined to be a viable alternative to telemedicine in this case. CF is a difficult disease under any circumstance but is more difficult in this case due to the lack of ability to easily access the specialized healthcare environment. Due to that difficulty, “telehealth can be an effective approach for communication and counseling.” (CDC, 2019 Remote Collaboration and Evidenced-Based Care Transcript)

Caitlyn’s plan of care involves supplementation of pancreatic enzymes, supplementation of fat-soluble vitamins, a diet of high protein, high caloric intake, aerosol treatments, and chest physiotherapy. Each of these interventions is difficult to implement without support, and given the time involved to drive each way to the hospital, the option of telehealth is viable, as, according to Dorsy et al., in their paper, “State of telehealth”, telehealth communication increases access to care for population groups that would not normally have access. (Dorsey & Topol, 2016) This benefits Caitlyn’s parents, as they work long hours and are unable to take time off for every difficulty they encounter. Given the circumstances of their situation, telehealth will ease some of the stress involved in their sharp learning curve that needs to be monitored for consistency, correct process, questions that arise, and support as “better monitoring can improve patients’ quality of life and reduce hospital admissions,” from the CDC’s 2019 Health Promotion statement. (CDC, 2019)

Evidence-Based Care Plan and Patient Safety

The care plan developed for Caitlyn would include medical management, pharmacological management and nursing management. Medical management would include diet, monitoring for growth and development, and vaccines. Pharmacologic management includes pancreatic enzymes, vitamins, such as, A, D, E, K, biotin, folic acid, niacin, pantothenic acid, the B vitamins, vitamin C, and bronchodilators. Nursing management includes a parental interview of familial history, assessment of caregiver’s knowledge, vital signs, and assessment of skin condition for bruising from frequent cupping therapy. Each of these is daunting in and of itself, but when adding distance to the equation, good patient outcomes can be hard to achieve.

However, using telemedicine, the initial care team was able to promote quality care by ensuring Dr. Benjamin had access to the team’s management strategies, the social workers were able to provide collaborative care through telemedicine and Janice had support through a telemedicine conference with the respiratory therapist. Davis et al., in their 2020 paper, “Designing a multifaceted telehealth intervention for a rural population using a model for developing complex interventions in nursing”, stated that telehealth offers an evidence-based approach through patient education, convenient communication times, and shared goals by linking scattered healthcare professionals (Davis et al., 2020) In their 2019 paper, “Impact of Telemedicine on Healthcare Service System Considering Patients’ Choice”, Wang, Zhang, Zhao, and Shi, state that telehealth provides easier access to medical specialists, efficiency of health care delivery through early identification and intervention, shortened wait times through the utilization of efficient health care resources.

Evidence-Based Practice (EBP) Model

Telemedicine is being integrated into the delivery of health care. But, implementing it is not enough. In order for the care team to ensure all available resources are accessible, collaboration is needed from all healthcare professionals involved in Caitlyn’s care. Kamsu- Foguem, et al., stated in their 2015 article, “Modeling for effective collaboration in telemedicine”, that collaboration ensures that medical professionals with shared decision-making are up-to-date with the course of the care plan making each professional responsible for his/her actions and decisions. (Kamsu-Foguem, Tiako, Fotso, & Foguem, 2015) The best way to establish good collaboration is to “communicate with intention.” Dhawan and Chamorro- Pemuzic, in “How to collaborate effectively if your team is remote”, state that communication can never be too clear as it is too easy for others to misinterpret. (Dhawan & Chamorro- Premuzic, 2018) The use of online meetings in caring for Caitlyn aids in discussion of needed adaptations, further treatment, education lapses and reassurances that the mother is not alone during this critical time. As this is a chronic illness, long term care needs to focus on sustainability. If Caitlyn’s mother does not have easy access to medical solutions, then she may unintentionally lapse into poor care of her child. By addressing the mother’s needs as well as Caitlyn’s needs, EBP will help adopt a care plan that is adaptable and suitable for sustainability.

The Most Relevant and Useful Evidence in Making Care Plan Decision

When making a usable care plan, it needs to be both relevant and goal attainable.

According to Peter, et al., in their 2015 paper, “Reducing Readmissions Using Teach-Back”, teach-back helps clarify the learner’s understanding and what specific points the teacher needs to address to ensure the learner is understanding. Coordinating the team through interprofessional collaboration aids in clear communication and allows for effective teaching strategies. As it is easy to reveal areas learners may not understand through a teach-back scenario, it is easy to adapt the information to educate the learner. (Peter et al., 2015)For Caitlyn’s parents to continue to assist her during their learning phase, telemedicine is vital for success. It will provide support, information, feedback and relieve anxiety during the initial sharp learning curve.

Benefits and Strategies to Mitigate the Challenges of Interdisciplinary Collaboration

The challenges faced by Caitlyn’s parents can become obstacles if not addressed. Those challenges include distance from the hospital, long work hours, the separation of her parents, Caitlyn’s age and lifestyle changes that a chronic medical condition imposes on the family.

Through the collaboration of healthcare professionals, Caitlyn’s quality of life can be improved. If the parents have easy access to available healthcare, their participation would be greatly enhanced, which would also benefit Caitlyn. In their 2016 paper, “Clinical Practice Guidelines From the Cystic Fibrosis Foundation for Preschoolers With Cystic Fibrosis”, the authors acknowledge that the care of the preschool-age child presents its own set of difficulties from the time-consuming treatments to the complexity of those treatments. For her parents to gain knowledge, support and positive feedback for her care, telehealth is a necessary part of her treatment plan. (Lahiri, et al., 2016 Remote Collaboration and Evidenced-Based Care Transcript).

Interdisciplinary collaboration gives her parents the opportunity to support Caitlyn through the latest medical advancements and the advanced skill set of the specialists involved. Telehealth will be an effective healthcare approach, aiding in communication, counseling and provides ‘in the moment solutions’. Telehealth provides an easily accessible way for the healthcare team to monitor Caitlyn’s progress. (CDC, 2017). With the advent of telehealth, EBP continues the gold standard of care for the patient. Aiding in learning, consultation, monitoring, etc., telehealth relies on EBP to continue to give quality care to those who are unable to access traditional medical systems.

References for Remote Collaboration and Evidenced-Based Care Transcript

Centers for Disease Control. (2017, August 2). About rural health. Retrieved June 29, 2020, from Centeres for Disease Control and Prevention: https://www.cdc.gov/ruralhealth/about.html

Centers for Disease Control. (2019, May 31). National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP): Telehealth in rural communities. Retrieved July 2, 2020, from Centers for Disease Control and Prevention: https://www.cdc.gov/chronicdisease/resources/publications/factsheets/telehealth-in-rural- communities.htm

Davis, S. M., Jones, A., Jaynes, M. E., Woodrum, K. N., Canaday, M., Allen, L., & Mallow, J. A. (2020). Designing a multifaceted telehealth intervention for a rural population using a model for developing complex interventions in nursing. BMC Nursing, 19(1), 9. doi:10.1186/s12912-020-0400-9

Dhawan, E., & Chamorro-Premuzic, T. (2018). How to collaborate effectively if your team is remote. Harvard Business Review Digital Articles, , 2-5. Retrieved

from http://library.capella.edu/login?url=http://search.ebscohost.com/login.aspx?

direct=true&db=bth&AN=128465661&site=ehost-live&scope=site

Dorsey, E. R., & Topol, E. J. (2016). State of telehealth. The New England Journal of Medicine, 375(2), 154-161. doi:10.1056/nejmra1601705

Kamsu-Foguem, B., Tiako, P. F., Fotso, L. P., & Foguem, C. (2015). Modeling for effective collaboration in telemedicine. Telematics and Informatics, 32(4), 776-786. doi:10.1016/j.tele.2015.03.009

Lahiri, T., Hempatead, S. E., Brady, C., Cannon, C. L., Clark, K., Condren, M. E., … Davis, S D. (2016, April). Clinical Practice Guidelines From the Cystic Fibrosis Foundation for Preschoolers With Cystic Fibrosis. Pediatrics, 137(4), 1-26. http://dx.doi.org/10.1542/peds.2015-1784

Lang, R. L., Wilson, C., Stockton, K., Russell, T., & Johnston, L. M. (2019). CyFiT telehealth: Protocol for a randomised controlled trial of an online outpatient physiotherapy service for children with cystic fibrosis. BMC Pulmonary Medicine, 19(1), 21. doi:10.1186/s12890-019-0784-z

Peter, D., Robinson, P., Jordan, M., Lawrence, S., Casey, K., & Salas-Lopez, D. (2015).

Reducing readmissions using teach-back: Enhancing patient and family education. The Journal of Nursing Administration, 45(1), 35-42. doi:10.1097/NNA.0000000000000155

Wang, X., Zhang, Z., Zhao, J., & Shi, Y. (2019). Impact of telemedicine on healthcare service system considering patients’ choice. Discrete Dynamics in Nature and Society, 2019, 1- 16. doi:10.1155/2019/7642176