Submitted by Rebecca Collins RN, BSN, OCN, CHPN

Hospice has long been seen as a way to provide comfort through effective symptom management for terminally ill patients. Controlling a patient’s symptoms allows hospice patients to experience a better quality of life with the added benefits of decreasing emergency room visits and avoiding hospital stays. Now that hospitals face penalties for readmission of patients with certain chronic conditions, Hospice of Dayton’s Focused Care program not only benefits the patients from a quality of life standpoint, but also the hospitals with readmission avoidance.

Focused Care is a specialized program of treatment that is tailored to address disease specific issues of hospice eligible patients with cancer, cardiac or pulmonary diseases. The Focused Care model uses concepts such as critical thinking algorithms, assessment guidelines, contingency orders, along with promoting collaboration between the community and hospice medical teams. After putting all the above processes in place, we recognized that we needed a way to monitor those cardiac and pulmonary patients in our program that were deemed to be the most fragile. Thus the next step was to add a tele-monitoring component to Focused Care.

Hospice of Dayton is currently the only hospice program in the area that uses tele-monitoring in the care plan for their patients. We have 20 of these user friendly devices that prompt the patients daily to complete their vital signs along with answering a set of disease specific questions. The data is transmitted each day for review by the two Focused Care Nurses during the week and triage nurses on the weekends. Admittedly, the word “micro-management” can have a negative connotation, but not in the case of monitoring our Focused Care patients! If a patient’s report shows adverse vital signs or increased disease specific complaints, the Focused Care Nurse will phone the patient real-time to further assess their needs. If necessary, patients can be instructed to use PRN medication as outlined in their contingency orders or an on-call nurse visit can be arranged for further assessment. These trends can then be reported to the hospice and attending physicians to further guide the plan of care.

Daily monitoring also provides a connection to the patient, addressing the potential isolation or anxiety that patients can experience with end-stage CHF and/or COPD. Patients learn to trust that if they have adverse signs or symptoms, they won’t be directed to go to the hospital, but can stay in their home setting and have their issues addressed quickly and efficiently. The total Focused Care approach serves to further highlight how the hospice approach to symptom management for terminally ill patients can provide positive outcomes and prevent unnecessary hospital readmissions.

Do you currently use tele-monitoring in your practice? What has your organization found to be effective in symptom management for those patients suffering from chronic conditions in the outpatient setting? Has your organization made any adaptations when providing care those patients with end-stage cardiac or pulmonary diseases?

Further information on the Hospice of Dayton Focused Care Program can be obtained at: http://www.hospiceofdayton.org/main/services/care-services.