28) Telemedicine Ventilator Rounding
in the Intensive Care Unit
Ruth Anne Skinner, DNP, ACNP-BC, and Pamela Love, DNP, RN
Grand Canyon University
Background: Advancing the scientific knowledge in the
teleICU is important because it is a newer modality in
healthcare and has potential for incredible growth. Ven-
tilator rounding is the assessing and verifying ventilator
management of mechanically ventilated patients to en-
sure usage of the most recent evidence based research.
The purpose of this direct practice improvement project
was to evaluate the effectiveness of ventilator rounding
by nocturnal telemedicine nurse practitioners as mani-
fested by improved daily compliance of ventilator bundle
and lung protective ventilation for adult mechanically
ventilated patients.
Methods: A quantitative simple correlation design was
used for both clinical questions. The dependent variable
was the respective compliance percentage on that given
day. The independent variables were the retrospective
compliance percentage on the given day and the number
of days since ventilator rounding practices were institut-
ed (N=40).
Results: Improved ventilator bundle compliance in-
dicated a moderate, statistically significant, positive
correlation, r = .41, p = .008, between the two variables.
Improved lung protective ventilation indicated a weak,
not statistically significant positive correlation, r = .14, p
= .39.14. The DPI project was clinically and statistically
significant noting that all three hospitals improved their
length of stay and improved the days intubated. Howev-
er, it is recommended that a future project evaluate the
relationship between ventilator rounding and days in the
ICU. The project supports the continued use of ventilator
rounding to improve ventilator management.
Conclusions: The professional and practical implications
were to increase daily compliance of lung protective
behaviors. The significance of the project was the pre-
vention of ventilator associated complications which
supports the continued use of ventilator rounding to
improve ventilator management. Keywords: ventilator
rounding, teleICU, acute care nurse practitioner, mechan-
ical ventilation, ventilator bundle, and lung protective
ventilation
29) Integrating Medication Management
Services within a Mobile Integrated
Health (MIH) Model Leveraging Telehealth
Olufunke Sokan, RPh, MS Pharm, Folasade Osotimehin, PharmD,
BCACP, Magaly Rodriguez de Bittner PharmD, BCPS, Todd Crocco,
MD, FACEP, Colleen Landi, MS, CRNP, David Marcozzi, MD, MHS-
CL, FACEP, Mark Fletcher
University of Maryland School of Pharmacy, University of
Maryland Medical Center, Baltimore City Fire Department
Background: More than 80% of Baltimore City Fire
Department (BCFD) 911 dispatches are for Emergency Medical
Services (EMS) resulting in transportation to the Emergency
Department (ED). An estimate of about 32% of these EMS
calls could be safely treated outside the hospital setting. This
utilization pattern has led to a disproportionate devotion of ED
personnel and financial resources to providing non-urgent care.
In addition, this places a significant strain on the BCFD system
and response time.
Methods: A unique model was established to deliver quality
healthcare to low acuity patients and support the health of
West Baltimore residents over utilizing EMS and ED services.
The multidisciplinary model comprises mainly of a 2-person
on-scene care team, a BCFD community paramedic and BCFD
nurse. An Ad vanced Practice Pharmacist provides support
to the team from a remote location. The Pharmacist is able
to participate during the patient’s home-visit using a HIPAA
compliant Telehealth solution (Zoom video technology).
An additional technology (DocHalo) allows for immediate
communication between team members. Patient home-visits
occur the next business day post discharge. These patients are
followed for 30 days and transitioned back to their PCP for
continued management. Documentation by all team members
occurs within EPIC.
Results: Telehealth has afforded the incorporation of
Pharmacy from a remote location within a MIH care model.
Over a two month period, 32 patients have been enrolled in the
program. Pharmacy has conducted 30 virtual visits and resolved
25 drug related problems.
Conclusions: The MIH innovative TOC model aims to reduce
overutilization of ED and improve the health of West Baltimore
residents while addressing the drug related problems during
a transition of care right at the patient’s home by leveraging
Telehealth. This approach makes pharmacists available and
present in a virtual capacity expanding access to this important
resource within a multidisciplinary team.
SPECIAL THANKS TO THE FOLLOWING ARIZONA TELEMEDICINE PROGRAM STAFF:
Cassandra Coray, Ellen Dudzik, Kris Erps, Michael Holcomb, Angel Holtrust, Robert Kerr, Janet Major, Chris Martin,
Karen Miller, Nancy Rowe, Tracy Skinner, Phyllis Webster, and Pete Yonsetto
Telemedicine Telehealth Service Provider Summit
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