By Megan M. Krischke, contributor
March 15, 2013 - ICU nurses who work in a telemedicine setting have new guidelines to help them provide the best in remote patient care and support. The Tele-ICU Nursing Practice Guidelines, issued by the American Association of Critical-Care Nurses (AACN) last week, are the first authoritative practice guidelines issued for the tele-ICU nursing subspecialty.
Currently, the 40-plus tele-ICUs in the United States serve 10 percent of ICU patients in more than 250 hospitals.
“Publishing the guidelines is a huge and exciting step,” expressed Connie Barden, RN, MSN, CCRN-E, CCNS, director of telehealth initiatives at Miami’s Baptist Health South Florida and co-chair of AACN’s tele-ICU task force. “Ten years ago this was a brand new subspecialty. It has emerged and grown over time to become a valued contributor to patient care.”
“The guidelines give shape to tele-ICU nursing and help us know how to do our craft," she added. “And it comes from a valid and reliable source, because AACN is considered the leader in high acuity and critical care nursing throughout the world.”
Theresa M. Davis RN, MSN, PhDc, NE-BC, said that AACN has worked very closely with tele-ICUs to identify the skills and competencies nurses need to be successful.
“We wanted to communicate the expectations of what should be present in every tele-ICU, whether it’s a new one or one that is already up and running,” added Theresa Davis, RN, MSN, NE-BC, of Inova Health Systems in Falls Church, Va., who also helped co-chair AACN’s tele-ICU task force. “The task force worked for two years to create this tool to help both clinicians and managers evaluate individual and unit practice.”
Tele-ICUs focus on increasing quality and safety. The Leapfrog Group has stated that every ICU needs an intensivist; a tele-ICU allows hospitals to meet that initiative, as well as decrease falls and errors, follow best practice principles and ensure that patients are getting the medications and interventions they need when they need them.
The critical care nurses and physicians working in a tele-ICU are typically monitoring patients from a remote location connected to patient rooms via high-fidelity cameras and microphones. Patient records and data collected from the monitors are received electronically.
“A tele-ICU nurse does everything that a bedside critical care nurse does except putting hands on the patients,” explained Barden. “We bring a second set of expert eyes and ears and to help care for patients. We are part of the care team, helping to assess and evaluate patients, suggesting interventions and collaborating with nurses at the bedside. It is required that tele-ICU nurses have the full knowledge and skills that a bedside nurse does.”
Connie Barden, RN, MSN, CCRN-E, CCNS, believes tele-ICUs are an investment in safety and quality.
A tele-ICU nurse can watch over 30 to 40 patients. They proactively “round,” assessing ventilator settings, IV drips and making sure things are going according to the care plan. They can help prevent falls by virtually entering the room of a patient who is trying to get out of bed. Additionally, subtle nuances and changes are picked up by their computer systems, alerting them to check on a patient to determine if the situation is a normal variance or if it requires attention. The tele-nurse is also able to quickly contact the bedside nurse if hands-on attention is required.
“Tele-ICU nurses don’t replace bedside nurses--we’re a support system and a safety net,” asserted Davis. “We aren’t ‘Big Brother,’ watching. We are there to support the team on the ground and make sure the patients get what they need.”
“Tele-ICU nurses have to learn new styles of communication and collaboration to build strong relationships of mutual respect and trust with those on the critical care site,” she continued. “We have to pay even more careful attention than usual to tone of voice, how people perceive us and focus on providing excellent service to patients, their families and our clinical colleagues at the bedside.”
“I think we can expect to see the specialty grow,” commented Barden, who is also national past president of AACN. “Technology in health care today is still very expensive, but as the data on outcomes grows and as more hospital leaders gain information about how they can leverage their resources, the availability of tele-ICUs will expand. It isn’t going to be sudden; my belief is that it will be slow and steady. Telehealth is the way of the future. This technology enables an efficient use of people, time, knowledge and ability.”
“I hope that nurses know that this resource [tele-ICU] is there to serve them and that there is always someone there to consult with--a fellow nurse and a physician. Our greatest goal is to provide them the support they need,” concluded Davis.
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