Colleen Gallagher, Director of Special Programs, Natick Visiting Nurse Association, Natick, MA

The telemonitor can be a valuable tool for palliative care patients because it is seven day a week monitoring.  We can catch the little changes that might signify a looming big problem before it becomes one. The fact that an RN is on the other end of the phone line provides reassurance also. A patient who is palliative care wants a comfortable death but doesn't want to die sooner than they have to!

The nurse both on the monitor and in the home can help the patient and their care givers to learn the skills they need to manage their care more effectively and hopefully improve their quality and quantity of life. Also, because of the questions that we can program into the monitor, it helps us to get a better idea of any problems that they might have, whether it is a problem with their medications or that they might have fallen or any one of up to fifty-one questions.

We have had several instances of patients who were discharged home from the hospital and placed on the monitoring service because there was nothing more that could be done for them medically and they weren't surgical candidates.  We are currently in the process of developing disease management programs for Heart Failure and then for COPD, both chronic diseases for which their is no cure and for which the monitor will play a primary role in helping to manage their care. Because of its ability to track and trend vital signs which we can in turn send to the physician, telemonitoring should help them to adjust medications more accurately which should help with improved patient stability over time. We are also using it for patients undergoing chemotherapy and/or radiation to monitor vital signs, weights, etc., with the intention of transitioning off telemonitoring if they improve or continuing on if they don't. We find that telemonitoring provides both the patients and their spouses/caregivers with a great measure of reassurance and support as well as acts as a teaching tool to help identify problems.

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